• Margaret B Harrison, Ian D Graham, Karen Lorimer, Elaine Friedberg, Tadeusz Pierscianowski, and Tim Brandys.
• School of Nursing, Queen's University, Kingston, Ont. harrisnm@post.queensu.ca
• CMAJ. 2005 May 24; 172 (11): 144714521447-52.

BackgroundLeg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers.MethodsInternational practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage.ResultsThree-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 (p = 0.041); the median supply cost per case was reduced from 1923 dollars to 406 dollars (p = 0.005).InterpretationReorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.

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