Diabetic foot ulcers represent a common indication for hyperbaric oxygen (HBO) therapy. Broad acceptance currently exists by those in a position to refer such patients as well as by those who purchase health care. Despite this, its use has recently been called into question. A large retrospective analysis published in a highly regarded medical journal failed to demonstrate any healing improvement, nor any reduction in extremity amputation rates, the two very outcomes purported to be enhanced by HBO therapy. Also included in these research findings was an inference that lengthy, costly and medically unnecessary courses of HBO therapy are commonplace.
In this era of health care cost containment and demands for better evidence (proof) of clinical effectiveness, the above referenced research has gained some notoriety. While 'line item' costs are high, it is argued that incorporation of HBO within standard management serves to reduce overall health care expenditures. Of course, this assumes that wounds are healed, limb amputation rates reduced, and resultant quality of life enhanced. As noted, however, there exists a compelling argument to the contrary. In the absence of better supportive evidence of improved patient outcomes, referrals may diminish, reimbursement policies may be reconsidered and the long term viability of hyperbaric medicine threatened.
Webinar participants will be exposed to a key evaluation and case management tool, one that when used algorithmically contributes to improved patient outcomes and a reduced financial burden on the health care delivery system. The tool in question is transcutaneous oximetry. This diagnostic screening process was largely absent in the above study's patient population.
Where employed, it identifies reversible local hypoxia. This confirmation of the physiologic capacity to respond locally to systemically delivered oxygen guides selection of clinically appropriate hyperbaric candidates. In such patients, its subsequent application will indicate adequacy of hyperbaric treatment pressure and guide determination of therapeutic endpoint. The sum of all of this is the provision of HBO therapy that has been demonstrated as medically necessary, with higher expectations of improved clinical outcomes, and delivered in a more financially responsible manner.
Dick Clarke, CHT. President, National Baromedical Services, Inc. President, National Board of Diving and Hyperbaric Medical Technology