Why Curative’s approach wins so many kudos; the company speaks out

The keys aggressive and interdisciplinary care

(Editor’s note: In the August issue of Wound Care, we published a report about the use of growth factors in the treatment of chronic wounds. One growth factor combination in particular, Procuren, is manufactured and widely used by Curative Health Services in East Setauket, NY. A number of sources questioned Curative’s claims about Procuren’s efficacy, but those same sources also praised Curative’s overall approach to wound care. One critic of Procuren said of Curative, "All wound care programs should be as good as that."

To find out what makes Curative so successful in chronic wound management, we spoke with Pat Schutzius, MSN, RN, CWCN, Curative’s director of medical services, and Mark Doyne, MD, vice president of medical affairs. Below are excerpts from that conversation.)

Wound Care: Describe Curative’s approach to wound care.

Mark Doyne: The foundation of what we do is to take an overall approach to wound care. We don’t rely on any one course of care as the be-all and end-all. Rather, we view each step as one part of a larger plan. Our philosophy is rooted in the notion of interdisciplinary care. I emphasize interdisciplinary vs. multidisciplinary care. There’s a subtle but important difference between the two in terms of the various people and professionals working together. We encourage an interdisciplinary approach to chronic wounds.

Pat Schutzius: We treat patients according to evidence-based clinical pathways that specify very rigorous comprehensive assessment to first determine what’s wrong with the patient. We need to first know why a patient has developed a chronic wound before we can decide on the best treatment. Certain elements associated with that wound must be addressed whether it’s adequate perfusion of blood, getting rid of infection, controlling diabetes, improving compliance, or making sure a patient protects or taking weight off an at-risk area before that wound can be healed.

Doyne: We do take an aggressive approach to surgically debriding or excising wounds. And frequently we do it early in the care regimen. The idea is to change a chronic wound to an acute wound and to restimulate the body’s natural healing processes. One of the fundamentals of what we do is to surgically debride a wound of nonviable tissue.

WC: Elaborate more on the idea of interdisciplinary care.

Schutzius: Each physician associated with Curative is asked to be a team leader. A team consists of nurses, case managers, social workers, educators, nutritionists, and pedorthists, as well as any other medical specialist who is brought in on an as-needed basis, such as a plastic surgeon, a vascular surgeon, a podiatrist, or an endocrinologist. We’re tapping into a whole host of professional resources. And each clinic has a medical director who is accountable and responsible at the local level.

WC: How many patients have been treated at Curative centers?

Schutzius: We have approximately 150 points of service in 40 states and Puerto Rico. They range from outpatient facilities associated with hospitals, to freestanding centers, to inpatient programs. Some are housed in rehabilitation facilities. In 1997, we expect to treat in excess of 50,000 new patients. Since 1988, we’ve treated between 150,000 and 200,000 patients.

WC: Can you summarize Curative’s wound care process?

Doyne: At each visit, certain parameters of a patient’s wound are entered into a database. One of the major variables is wound volume. Based on the patient’s progress or lack thereof, we review any possible reasons for nonhealing or nonresponse to treatment so that we can change the plan of care accordingly. That way, we can adjust each patient’s treatment at each visit.

Schutzius: At our case review or case management meetings, which most of our centers hold monthly, we bring back objective information on wound volume and general patient progress. Photographs of a wound often are included in a patient’s file. We keep track of healing rates by physician so that each of them can understand their overall performance compared with national benchmarks. Each clinic also has its rate of healing ranked. The feedback is important for improving performance.

Doyne: Generally, we use the data for the purposes of internal quality management, though we have published some of our data in the literature after analyzing it. If you provide physicians with objective, meaningful, real-time data, it becomes a powerful tool for improving patient outcomes. Physicians are data- driven creatures, and they respond to it. We also make sure that our medical directors use the data that we collect. Wound care packs designed for home use.