Over the last 2 decades, there has been a proliferation of wound care professional organizations in the United States that publicize various options and venues for education, training in general, and professional certification in particular. Some of these activities are linked to the increasing number of wound conferences. This surge of professional activity has moved wound care from a cottage industry to a distinct medical care profession as recognized and standardized by various certifying and accrediting bodies. In response to the growing number of wound care programs and professions, some have suggested the need for a unified Commission on Accreditation of Wound Care Organizations, which would include private, hospital, and research-based organizations.
Various credentialing opportunities are available to wound care practitioners and appeal to those who wish to add educational opportunities, credentialing, certification, fellow status, or further qualification to their primary degree or license.
A simple web search lists countless wound care-related certifying resources, including, but not limited to, the Wound, Ostomy and Continence Nursing Certification Board and the Accreditation Board for Specialty Nursing Certification (historically the oldest certifying body in wound care, since 1978)1; they are certified by the National Commission for Certifying Agencies (NCCA). The NCCA manages the Institute for Credentialing Excellence in providing services to several sectors including education.1,2 The National Alliance of Wound Care and Ostomy offers certification as a Wound Care Certified Nurse.1,3 The associated Wound Care Education Institute offers a multitude of educational "onsite and online education options" and collaboration.3 The American Board of Wound Management is also NCCA certified and offers multidisciplinary certification.2,5 The American Board of Wound Healing,5 whose certification examinations are recognized and endorsed by the American College of Hyperbaric Medicine, and the American Professional Wound Care Association6,7 provide professional conferences and pathways to credentialing to members from various multidisciplinary groups including those practitioners.3 A new entrant to the field is The Academy of Physicians in Wound Healing (APWH),8 which is listed exclusively as a "physician-specific organization." The APWH is open to all "prescribing physicians" (MD, DO, and DPM).4 The APWH collaborates with The Council for Medical Education and Testing for its credentialing process of physicians.9
Most of the "credentialing" organizations listed have focused on individual practitioner evaluation and testing to measure and allow the achievement of minimum standards for certification. And, most of these examinations place emphasis on the cognitive domains of knowledge (testing through item development). More work needs to be done in the evaluation of the affective and psychomotor domain (eg, clinical skills laboratory and active wound care).
The above list is not far-reaching but is intended as a broad brush to illustrate the activity in the wound care education and individual practitioner credentialing space. Given that most wound care specialists work in large multidisciplinary practices, wound clinics, and hospital-based centers, we should define that universe in the context of new models.
Wound care centers in hospitals come in a variety of configurations and can include a hyperbaric oxygen chamber. They are owned and operated by the hospital or by a separate wound for-profit company. Wound centers have proliferated for the same reasons other chronic care models (rehabilitation, skilled care, home health, and hospice/palliative units) and programs have grown. Americans are living longer and are more likely to be living with a chronic disease, including all of the comorbidities associated with impaired wound healing.10,11 This particular movement is also tied to the Affordable Care Act (Patient Protection and Affordable Care Act, HR 3590, signed into law by President Obama in March 2010) founded on the principles of healthcare accessibility, affordability, accountability, and patient safety.11
Although the principles and practices of wound care emanated as a practical clinical care concept at the individual practitioner level, newer healthcare delivery and practice models and taxonomies are evolving. These include multiprofessional teams, transdisciplinary teams, and interprofessional practices as promulgated by the Institute of Medicine in which we work in cross-functional teams.10
Currently, there are about 6356 hospitals in the United States.12 In 2012, about 3100 hospitals offered "wound management services." As of fiscal year 2013, there were 3165 hospitals that offered a combination of inpatient and outpatient wound care services; however, these are self-reported data from member hospitals (personal communication, American Hospital Association).
There is often conflation between the concepts of certification and accreditation; individual practitioners are certified by a professional organization and the process is voluntary.
Healthcare accreditation is defined as the process whereby an agency or association grants public recognition to a healthcare organization for having met certain established qualifications or standards as determined through initial and periodic evaluations requiring self-evaluation reports, site inspection by a team of expert survey teams, and evaluation by an independent board or commission such as The Joint Commission. Although The Joint Commission accredits hospitals, they certify wound programs. Currently, there are 26 certified programs.
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