AoU Research Priorities Use Cases

Analysis of the impact of payer on the outcome of patients with leg ulcers (including amputations) and race related differences

US Wound Registry data confirm outcome of African Americans with lower extremity wounds is worse than in whites, particularly true for DFU outcomes where amputation rates are higher. USWR data confirm use of advanced therapeutics in wound care is determined by payer. Whether a Medicare beneficiary has a secondary insurance determines if they get a cellular product, & use of all advanced therapeutics has changed with rise of Medicare advantage plans. We do not know if this has changed outcome.

The remaining questions allow you to outline in more detail the information needed to address your research question. The series of questions allow up to five entries. If you have more than five entries, please try to prioritize them and enter the remainder in the final field. When done, click Submit at the bottom. Yes

Select your required Data Item #1, which is most important to your study. This would be an item that needs to be generated and collected from different sources using various procedures, tools, techniques, assays, etc. If not in the current selection, please enter it in the textbox below. Air pollution measurements

If you did not find your Data Item #1 in the dropdown selection above, please enter it here. Amputation risk at the time of presentation (Q: Are A-A DFUs more severe than White counterparts when they first present and/or do their risk factors make them already more likely to be amputated- in other words, do they start at a disadvantage?) o Severity of the ulcers o Number of ulcers per patient and Wagner grade o History of Prior amputation o Known Pre-existing arterial disease o % on dialysis

By what method will Data Item #1 be obtained? This may Include procedures, tools, techniques, assays, and analytical approaches for the collection, measurement, or analysis of data. If you do not find the required method, you may enter it in the textbox below. Electronic Health Records (EHR)

If Data Item #2 was not in the dropdown, please enter it here.  Disease Management status (Have patients received basic evidence based treatment for underlying diseases?) o Medications for PAD (aspirin, Plavix, etc) o Medications for diabetes o Blood pressure control o A1C level if available

Method #2 Prescription records

If Method #2 was not in the dropdown, please enter it here Also EHR and Lab Results

If Data Item #3 was not in the dropdown, please enter it here  Health status at presentation (Disparities among patients by race or payer when they present with DFUs?) o smoking, method of arrival to clinic (e.g. wheelchair, walker) still working, average age, history of stroke, alcohol o BMI o Blood pressure control o ? immunization (is this an indicator of anything?)

Method #3 Electronic Health Records (EHR)

Specification #3 At specified times anchored to the clinical event

If Data Item #4 was not in the dropdown, please enter it here  Resource Use and treatment in the wound center: (Are there any measurable racial or payer differences in treatments provided at the clinic Level? And are these related to race or insurance or can we tell?) o Use of advanced therapeutics: NPWT, HBOT and cellular products o Number of debridements o Visit frequency o Total time in service o Use of DFU Off loading o Arterial screening o Other tests such as MRI, etc.

Method #4 Claims data

If Data Item #5 was not in the dropdown, please enter it here  Analyze Outcomes by Race or Payer: o Amputation of any part of the lower extremity o New ulcers while in service o Non healing o Lost to follow up o Outcome of HBOT o Outcome of cellular products

Method #5 Survey

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Idea No. 661