: This study is designed to demonstrate the clinical effectiveness and cost-effectiveness of utilizing telehealth technology to reduce the days to heal for chronic wounds. This will be accomplished through the utilization of health information technology to improve access to knowledgeable caregivers, point of care processes, and dissemination of best practice information. The study approaches wound care as a continuum of care addressing underlying etiology (diabetes) as well as the immediate wound treatment regimen. The study will be a controlled trial to evaluate a telehealth strategy, which incorporates evidence-based guidelines, by comparison to the current standard care provided in the community. The primary outcome measure will be the time to healing of the wound. The unit for allocation will be the different counties in Oklahoma, but the unit of analysis will be the individual patient. This strategy is used to avoid contamination of the standard care control group by the telehealth/evidence-based strategy, which would occur if the same providers in a county were delivering care in both the control and intervention groups. A true randomized allocation to the intervention or control groups is not possible due to logistic reasons, and to avoid withdrawal of telehealth services from counties in which this has already been implemented. We will minimize bias in allocation by using matching counties by their demographic and other characteristics, and then allocating counties within these pains to receive either the experimental telehealth intervention or the community standard care (control group). Bias in the assessment of the outcome of wound healing will be avoided by taking pictures of the wound, using a standardized method, at fixed intervals in all patients, and having these pictures interpreted by an independent clinical expert, without knowledge of the patient's group assignment, clinical features or other information. The study will incorporate a combination of broadband, analog, and web-based applications to serve patients in a variety of settings including clinics, homes and long-term care facilities. ? ?
