Dr Laura Bolton has presented significant research findings that not only have obvious implications for the specialized practice of wound care and home care but also could drive changes in national best practices, outcome expectations, and reimbursement criteria.

Findings can be used by certified wound care specialists to support implementation of standardized moist wound healing protocols. In the current environment of cost reduction, efficiency expectations, and measure outcomes, the research findings underscore the cost efficiency and achievable outcomes when using moderate cost treatment protocols early in the plan of care for patients with chronic wounds. This is certainly preaching to the choir of wound specialists, but it finally gives the specialist the data needed to validate standardized care practices in a real life setting. Although cohort size does not allow for direct application to other settings, home care should take note and make necessary revisions to care planning for chronic wound patients.

Just as important and perhaps even more far-reaching are the implications of the findings as they apply to nonprovider entities. The significant improvement in healing rates using standardized care may become the accepted and expected measuring stick employed by regulatory and accrediting bodies. With the advent of nationally published outcomes measures, providers are acutely aware of their position in relation to the "norm." This research could just become the beginning of raising the bar.

Finally, the effect the research may have on reimbursement criteria is important. Findings support the medical necessity and cost effectiveness of early intervention with a higher level of treatment and, conversely, do not support the common belief that may payers possess that you should start with gauze and "work up" to more advanced treatment protocols.

I applaud Dr Bolton's efforts and her contribution to the field of wound care. I believe this work should serve as a springboard for further practical research with application across all settings of care.