Title: Wounds research for patient benefit programme
Funder: Department of Health (England)

Abstract: Chronic wounds (defined as skin ulcers taking more than 4 weeks to heal) are common in the UK and throughout the developed world and their prevention and management occupies a great deal of nursing time and health care resource. There is ample evidence that chronic wounds are associated with high costs (the cost of prescribing wound dressings in England in 2006 was £122 Million) and reduced quality of life. Up to 32% of hospital inpatients and 7% of community based patients have a pressure ulcer whilst 1%- 2% of the population will develop a leg or foot ulcer during their life. Numbers are likely to increase as the population ages. The over-arching aim of this programme of work is to optimise the quality of care and outcomes for people with, or at risk of, chronic wounds. Currently there is a lack of high quality research and large variations in practice. We propose a 5 year programme to ensure that we make a real difference. Key deliverables will be increased knowledge about: - the epidemiology and management of chronic wounds in the community (eg, leg ulcers, foot ulcers and pressure ulcers, including chronic skin ulcers in hard-to-reach groups such as the homeless and intravenous drug users); - the feasibility and utility of establishing, populating and sustaining a Wounds Register; - important methodological issues that will increase the quality, fitness for purpose and efficiency of this and future research; - the effectiveness and cost effectiveness of prevention and treatment interventions; - factors which influence and promote the implementation of research findings into practice. The programme will also deliver improvements in practice and patient outcomes via a Knowledge Champion. The programme of work will comprise a cycle of 5 integrated workstreams (see Figure 1, Annex 4) within which we will also study health inequalities in wound care with attention paid to underserved communities including the homeless and intravenous drug users (both groups at high risk of skin ulceration but rarely featuring in research). This multidisciplinary team represents a successful and ongoing collaboration between Leeds PCT and the University of York; a partnership that has delivered (or is delivering) 3 major HTA funded trials (VenUS I, II and III) and recently acquired a project grant from the MRC for wound care research. Two service managers plus experienced practitioners from Leeds PCT ensure the required strategic and organisational capacity and clinical input. NS is the Clinical Team Leader for the Tissue Viability Service and collaborator VG is an experienced Tissue Viability Nurse. The input of TC from the Leeds No Fixed Abode team will contribute a unique perspective and ensure that the underserved are included in our research programme. Experienced researchers from the University of York will provide academic input led by NC who is Coordinating Editor of the Cochrane Wounds Group with over £4 Million in wounds research grants since 2000. The York team combines excellence in medical statistics, qualitative and quantitative health services research, evidence synthesis, clinical trials, epidemiology and health economics. The track record of this collaboration is testament to the host environment; Leeds and York are only 26 miles apart with excellent transport connections. Leeds PCT serves a diverse population of 720,000. The area served by the PCT is largely urban and suburban but also includes rural communities. Most patients with chronic wounds in Leeds are managed by community nurses. We will establish a Service User Advisory Group to ensure relevance for patients, carers and the local community. Workstreams are interlinked and iterative; epidemiological and service data capture will directly inform prioritisation whilst results of evidence synthesis and primary research will directly feed the implementation work. We have costed 3 FTE NHS staff including a Knowledge Champion to ensure uptake of best practice, and staff to develop and manage data capture. Three FTE research staff will undertake evidence synthesis, data analysis and primary clinical and methodological research. Necessary support staff and programme running costs are also included.


Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT)
Health categories: SKIN