Healing from the outside in: Developing a comprehensive wound care program in your HCH clinic

Patients experiencing homelessness often present with complex wound care needs. Delayed healing and development of chronic wounds among individuals without homes stems from the poor quality of dressings, need for frequent dressing changes, compromised nutrition, lack of a warm environment, and compromised health status. Clinic staff, particularly medical assistants, RNs, and PCPs, are often overwhelmed and under-trained to manage such complexity within the crush of a busy clinic day. This workshop will explore the needs and barriers to care for individuals experiencing homelessness with complex wounds, describing the evolution of an innovative, multi-disciplinary wound care clinic in an urban Health Care for the Homeless clinic. Participants will learn about staffing models designed to optimize each team member's time; flexible scheduling to enhance continuity and approachability by patients; and productivity and offloading algorithms to enhance the bottom line of the wound care program and primary care operations. Case presentations will highlight a comprehensive approach to evaluating the wound, assessing barriers to healing, addressing nutritional and functional status, and utilizing products appropriate to the patient's ability to manage the care plan. Innovative partnerships with payers to support adequate nutrition, with occupational therapists to enhance function and plastic surgery for difficult cases, provide an additional dimension to services. The workshop will also include a description of outcomes related to key performance measures such as time to wound healing; operational value and efficiency compared to specialty wound care clinics; increased primary care and wound care provider productivity; and other medical outcomes for chronic disease (e.g. anemia, diabetes, congestive heart failure). The workshop will conclude with an interactive discussion with a consumer of the wound care program, describing his experience recovering not only from years of chronic wounds but also from life on the streets, moving into supportive housing, recovering from addition, and general medical services as part of his healing process.