8 December 2016

National Quality Registry for Ulcer Treatment (RiksSår)

  • Registry Manager: Blekinge County Council
  • Registry Centre - affiliation: Uppsala Clinical Research Center (UCR)
  • Start year: 2009 and updated to RiksSår 2.0 in 2015
  • Classifications used: ICD10
  • This registry contains data on: Diagnoses, Treatment strategies, Pharmaceuticals, Interventions, Primary Care, Inpatient Care, Specialised Outpatient Care, PROM or other patient-reported health effects, Risk Factors, Continuous online follow-up until ulcer healing.

Description of the registry

Hard-to-heal ulcers include leg and pressure ulcers, diabetic foot ulcers, tumours, rheumatic ulcers and traumatic ulcers including damages during care or due to complications after surgical procedures. One percent of the population is affected at some point in their lives by some type of hard-to-heal ulcer and advanced age is the main risk factor. The majority of the patients have reduced quality of life with pain, sleep disorders and anxiety.

In Blekinge county (150,000 residents), RiksSår has contributed to a reduced prevalence, shorter treatment times, and a significant cost reduction for healthcare in the amount of SEK 7 million, which would correspond to 450 million if projected to nationwide figures.

Clinical patient-orientated research with data from RiksSår has shown a reduction in

  • healing time from 145 days to 53 days (2009-2015)
  • antibiotic treatment from 69% to 26% (2009-2015)
  • per-patient treatment costs by 46% (2009-2012)

The aims of RiksSår are to:

  • ensure that patients with a hard-to-heal ulcer get structured wound management with adequate diagnosis, optimal treatment and continuity of care until ulcer healing
  • promote interdisciplinary work
  • demonstrate healing time in clinical practice in relation to diagnosis and treatment
  • identify risk factors for failed or delayed wound healing
  • contribute to local and national quality development
  • contribute to rational antibiotic treatment
  • demonstrate the significance of lifestyle factors in wound healing
  • contribute to increased cost efficiency
  • generate new knowledge
  • contribute to structured documentation
  • provide data for national quality indicators for active wound healing
  • conduct clinical patient-oriented research

Population

RikSår aims at identifying the prevalence of different types of hard-to-heal ulcers, which is why the registry covers every kind of aetiology such as venous ulcers, arterial ulcers and venous-arterial ulcers, diabetic foot ulcers, traumatic ulcers, tumours and ulcers due to vasculitis or due to complications after surgery, as well as multi-factorial ulcers. Fresh data is needed on the prevalence of different types of ulcers.

Leg ulcer is one of our most widespread diseases, affecting 1 percent of the population at some point in their lives [LMB 2012]. In Sweden, it is estimated that more than 25,000 patients suffer from leg ulcers. The prevalence is expected to increase with an increasing number of older patients and patients with diabetes [Boulton et al.The Global Burden of the Diabetic Foot Disease. Lancet 2005 12: 1719-24 77].

SKL’s point prevalence studies from 2012 and onwards have shown that 12% - 16% of patients treated in community care have a pressure ulcer.

Data from RiksSår show that pressure ulcers constitute 12% of all ulcers.

There are some differences in patients with pressure ulcers compared with patients with other kind of ulcer aetiology in RiksSår.

Patients with pressure ulcers

Patients with other ulcer aetiology

Male patients 53%

Male patients 39%

No pain reported 67%

No pain reported 50%

Antibiotic treatment 16%

Antibiotic treatment 26%

 

The median age is 80 years both for patients with pressure ulcers and patients with any other kind of ulcer (range 7-103 years).

The registrations provide data for diagnosis and treatment and are broken down by inpatient care, primary care, community care and private care givers in order to elucidate the actual conditions about which we currently have insufficient knowledge.

The majority of patients with hard-to-heal ulcers are treated in primary care in over one thousand medical clinics. They are also treated in the 290 municipalities, in inpatient care clinics (25,556 beds, June 2011), and in 287 private medical clinics (August 2011). An estimated 3-4 patients have hard-to-heal ulcers per 1000 inhabitants.

RiksSår registers patients on two occasions: at assessment of the ulcer diagnosis and treatment strategy, and secondly at follow-up, at ulcer healing or at the occurrence of a negative clinical event such as amputation or death. Every patient with a non-healed ulcer remains in the registry until follow-up is completed.

Ages in the registry

All ages

Total volume of registry

25,000 patients with hard-to-heal ulcers

Volume over the past operating years (2009-2015)

4956

Coverage rate 2015

20%

Note: Variable lists are updated on a regular basis and should therefore be seen as preliminary. For the latest version, please contact the registry.

Category: Circulatory system

Certification level: 3

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