National Stakeholder Round-tableReport of the June 27 2012 Meeting

Wounds

Wound Care Alliance (WCA) Canada exists to pursue a Canadian wound management innovationagenda in which clinical, academic, industry and government expertise intersect to drive innovation,value and quality in wound care. The group’s founding members – the Canadian Association of WoundCare (CAWC), Canadian Association for Enterostomal Therapy (CAET), Ontario Woundcare Interest

Group (OntWIG), and MEDEC (the national association representing the medical technology industry inCanada) – made an initial commitment to (1) plan a wound management innovation meeting of key

stakeholders; (2) develop a policy paper based on the outcomes of the meeting and (3) advocate forthe adoption of the recommendations.

Thank you to the members of the Planning Committee for their expert advice.

Laura Teague, President, Ontario Woundcare Interest Group (OntWIG)Cathy Harley, Executive Director, Canadian Association for Enterostomal Therapy (CAET)

Peggy Ahearn, Executive Director, Canadian Association of Wound Care (CAWC)Fabien Paquette, Chair, MEDEC Wound Care CommitteeJohn Stone, Vice Chair, MEDEC Wound Care CommitteePeter Gardner, Member, MEDEC Wound Care Committee

Maureen Latocki, Acting Executive Director, Wound Care Alliance Canada

The perfect stormTiming could not be better for a wound care focused Centre of Excellence

In 2011, the World Health Organization and the United Nationsissued a warning that the major global health threat was notcommunicable but non-communicable disease – includingdiabetes and cardiovascular disease, both of which are linkedto chronic wounds.

Often overshadowed by higher-profile conditions, wounds are amajor and under-recognized health issue. While anyone inhospital, home-care and community-care managementrecognizes wounds as a big challenge, it comes as a surpriseand shock to learn that wounds take an annual economic toll of$3.9 billion in Canada – that’s 3% of total health costs!2

The enormous economic and social impact of wounds in Canada calls for greater attention tothis area of health care and more effective allocation of resources to prevent and treatwounds. A Canadian Wound Care Innovation Centre of Excellence (CoE) would make it possibleto achieve efficiencies that will transform service delivery and provide value for money.

The timing could not be better for a CoE for wounds. Recent developments suggest that thefederal government, the Council of the Federation representing the provinces, local healthauthorities, hospitals, and community/home care agencies are beginning to align around thewound care challenge. A CoE would be a hub for accelerating best practice, measuringoutcomes, building knowledge capacity, and fostering innovation. It’s a quick and easy win forpatients, practitioners and governments.

We congratulate Maureen Latocki for her vision and Wound Care Alliance Canada for theirsupport of the concept of a CoE as a mechanism for providing national leadership on woundmanagement in Canada. The June 27, 2012 stakeholder meeting confirmed that there is apowerful consensus to make wounds a national priority. We ask that you share this report withyour colleagues and join with us to raise awareness of the wound epidemic and bring evidence-based solutions to policy-makers and decision-takers.

Janet Davidson Tom ClossonCo-chair Co-chair

“Governments must take responsibilityand lead on these issues. They mustadjust their thinking to recognize thatspending on health care now is a real andnecessary investment that is far less of aburden than the un tallied cost of inac-tion… how their inaction is crippling theirhealth systems and ruining their econom-ic development.”1WHO 2011http://www.who.int/nmh/events/un_ncd_s

"This is personal for me. I have suffered with a chronic wound for four years and myexperience with the health system has been all over the map. As I speak to more andmore people, I see a huge vacuum in knowledge, capacity and awareness.

After today’s meeting, I have a renewed sense of hope having met so many dedicated peoplewho care deeply about this issue. That goes a long way to keeping hope alive for someonelike me."

Barbara Turnbull, Patient delegateAs a young high school student making pocket money at a convenience store, BarbaraTurnbull was gunned down on September 23, 1983 during a robbery at the end of a late-nightshift. She was just 18 years old. Today, Barbara lives her life as a high-level quadriplegic.

Table of Contents

Executive Summary

Wounds - The Hidden Epidemic

The Solution

Toward a Centre of Excellence

Five Pillars and Six Priorities

Future-gazing

Call to Action

Next Steps

References

Our Partners and Supporters

The Delegates

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3

4

5

6

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10

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Executive Summary

Wounds are an under-recognized health issue in Canada. While hospital, home and community caremanagers know that wound care is a major challenge, few are aware that wounds cost the Canadianhealth system $3.9 billion annually or ~3% of total healthcare expenditures.2 Some estimates suggest thiscost may grow by 30% in the next decade3 as a consequence of an aging population and the incidence ofchronic diseases including cancer, cardio-vascular disease, dementia and diabetes not to mention the86,000 Canadians living with spinal cord injuries who are at increased risk for developing pressureulcers.4

Wounds, increasingly being referred to as the hidden epidemic,5 have serious patient consequencesincluding intractable pain, infectious complications, hospitalization, reduced quality of life, depression,and increased risk of death.

On June 27 2012, thirty-five key opinion leaders representing Canadianhealthcare met to start a conversation about achieving efficiencies inwound prevention and care that will transform service delivery and improvevalue for money.

During the day, participants heard from a number of experts and engaged ina series of facilitated discussions. They highlighted the following issues: (1)a lack of local, regional, provincial, national standards of care; (2) frag-mented efforts to introduce product, process and program innovation in-cluding timeliness of health technology assessments; (3) the need to make

more efficient use of resources; and (4) insufficient Canadian data to support development and measure-ment of key performance indicators of outcomes and quality.

The conclusion - Canada can and must do a better job of improving patient outcomes by leveraging ourstrengths from coast-to-coast.

“Effective wound care connectsall the big health care agendas– value for money, quality, safe-ty, patient-centredness, and evi-dence-based practice .”Ray Racette, CEO, CanadianCollege of Health Leaders

► It is estimated that 30 to 50% of all health care involves wounds 6

► In the community, 50% of nursing visits involve wound care delivery 7

► 34 to 37% of persons receiving community care have a chronic wound 8

► 24 to 31% of persons in an acute or non-acute setting have a pressure ulcer 8

► At $3.9 billion per year, the cost of wound care exceeds that for stroke 9

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Executive Summary continuedLinking jurisdictions and organizations in pursuit of evidence-based wound management

The 35 delegates unanimously endorsed the conceptof a physical or virtual centre dedicated to reducingthe burden of wounds through leadership andinnovation with the down-stream impact ofimproving system accountability and sustainability.

It was further agreed that researchers, clinicians,and manufacturers need a mechanism forestablishing partnerships to drive R&D and raise thestandard of clinical practice. As a funnel for woundcare initiatives, education, and standards, aCanadian Wound Care Innovation Centre ofExcellence would offer an efficient and cost-effective solution to the wound care crisis in Canada.

More specifically the Centre would enable inter-professional collaboration; be a clearinghouse forprocess, methodology, models, tools and technology;serve as a subject-matter focal point and singular

voice; build and maintain an educated resource poolthrough training and hands-on experience; act as theliaison between industry, institutional andorganizational peers; and be a central repository fordata, research and study materials.

Next steps

Over the next 12 months, a number of commitmentsmade at the meeting will be actioned. These includesubmitting a brief to the Council of the Federation’sWorking Group on Health Innovation andparticipating in the Federal Government StandingCommittee on Finance’s pre-budget consultation;initiating discussions and establishing links withpartners; securing funding; pursuing opportunities toraise awareness with Canadian media; anddeveloping a partnership model that will strengthenour ability to achieve our goal.

The goal

To improve outcomes for persons

with a wound or at risk of

developing a wound while

ensuring value for money.

The proposed mandate

To serve as a concerted voice,

act as a bridge between

stakeholders, facilitate

collaboration, attract resources

and be a central repository of

data.

The desired impact

To prevent wounds, reduce healing

time, reduce recurrence, reduce

system costs and reduce patient

pain and suffering.

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Wounds - The Hidden EpidemicSounding the alarm

We are in the midst of a genuine national health epidemic. Wounds have an enormous and under-appreciated impact on individual Canadians, Canadian society, and the Canadian healthcare system.Implicated in an estimated 30 to 50% of health care 6, wounds threaten productivity, quality of life, andsometimes life itself.

Canada is not alone in grappling with the burden of wound care. The 2010 study “Cost of wound treatmentto increase significantly in Denmark over the next decade” demonstrated thatchanges in demography, life expectancy and incidence of background diseases(including type 2 diabetes mellitus) during the period 2009–2020 will increasetheir costs by 30%.4

Millions of Canadians suffer the physical and psychological consequences ofwounds yet little attention is paid by policy makers and the public. As a resultthere is a mismatch between the economic burden of wounds and the dollars

invested by governments in finding a solution.

Delegates to the Round-table identified several systemic barriers to effective wound care:

► Lack of systematic focus on the needs of the end-users of wound care research and service delivery

► Lack of accountability in benchmarking and reporting on wound care services and costs

► Lack of quality measures leading to an inability to assess value for money

► Lack of equitable access to services and supplies (notably in First Nations, Inuit, northern and rural

populations)

► Lack of focus on wound care as a separate professional specialty

► Lack of professional and public education.

The conclusion was that Canada has the necessary assets to not only provide pan-Canadian leadership onwound management but also to potentially take a global leadership role.

The economic implications

Wounds are estimated to costCanada's health care system $3.9billion, which exceeds the $2.5billion the country spends everyyear on stroke. 2,9

Not included in this cost estimateare the Indirect costs including (1)mortality costs associated with theloss of economic output as aconsequence of premature deathand (2) long-term disability costsassociated with lost or reducedproductivity because of absencefrom the workforce.

The clinical implications

Wound healing is complex andtakes place across the continuumof care - acute, community andlong-term. Transitions betweensectors are uncoordinated, oftenresulting in set backs in apatient’s condition.

Healing is impacted by acombination of factors includingco-morbidities; poor tissueperfusion; infection; copiousexudate; malnutrition;inappropriate training andunavailability of products,services and programs.

The personal implications

Patients with wounds experiencephysical effects that include pain,odour and discomfort.

The loss of mobility caused bywounds affects people’s ability toparticipate in work and leisureactivities, which often leads todepression.

Wounds take a toll not only onaffected individuals, but on thecare-givers who provide physicalassistance and emotional support.

“The first time I saw a diabet-ic foot ulcer, I was horrified.”

Tom Closson,Health Consultant

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The SolutionMoving toward a Canadian Wound Care Innovation Centre of Excellence

Thankfully, awareness of the wound-care crisis has been growing, and stakeholders have responded with anumber of regional and local initiatives. Within its health care portfolio, the Ontario Centres of Excellence(OCE) program is currently supporting several projects in the wound care area. Making wound care a priorityhas led a Local Health Integration Network in the North Simcoe area in Ontario to realize substantial savings,and a Sherbrooke, Quebec initiative has effectively introduced a tele-medicine initiative to support woundcare in rural areas.

While promising, these efforts are isolated and do not go far enough to spread improvements broadly formaximum system impact. Canada needs a national wound care strategy that addresses current gaps andneeds and embraces the following principles10:

► Person-centred: a system that integrates a patient and family perspective

► Accountable: a transparent system that informs stakeholders about costs and performance

► Efficient: a system that tracks and analyzes results to ensure a good return on investment

► Equitable: a system that reaches all irrespective of geography, socioeconomic or disease status

► Sustainable: a system with built-in processes to ensure efficiencies can be maintained over the long term.

Why a Centre of Excellence?

The goal of a Canadian Wound Care Innovation Centre of Excellence (CoE) is both simple and ambitious: toimprove patient outcomes and value for money. With an emphasis on innovation, simply defined as anythingbut business as usual, a CoE would be the hub for exploring all forms of innovation - products, processes andprograms.

Specifically, a CoE would (1) enable inter-professional collaboration; (2) be a clearinghouse for process,methodology, models, tools and technology; (3) serve as a subject-matter focal point and singular voice; (4)build and maintain an educated resource pool through training and hands-on experience; (5) act as the liaisonbetween industry, institutional and organizational peers and (6) be a central repository for data, researchand study materials.

Round-table participants unanimously agreed that a CoE would effectively address the gaps and needs theyidentified, while putting Canada at the leading edge of this evolving area of health care. Most significantly,the CoE would give stakeholders a mechanism for driving R&D, establishing partnerships and improving andsustaining standards of care and educating health professionals and the public.

Building on the success of others

Two presenters at the Round-table described how previous CoE-based initiatives are increasing the effectiveness andefficiency of wound care delivery. Dr. Bettina Klenker, manager of technology transfer at the Ontario Centres ofExcellence (OCE) program, outlined the program’s contribution to the province’s health innovation ecosystem, includingseveral projects in the wound care area. Dr. Douglas Queen, a Toronto-based consultant, described the creation of aWelsh Wound Innovation Centre and an Australian Wound Management Innovation Cooperative Research Centre. BothCentres are opening up the innovation pipeline with the ultimate aim of improving wound prevention and care.

As a potential model for wound care, the Technology Evaluation in the Elderly Network (TECH VALUE NET) is the latestNetwork of Centres of Excellence (NCE) to receive support from the Government of Canada. With $23.8 million infederal funding, TECH VALUE NET, located in Kingston, Ontario, will coordinate clinician researchers, Canadianuniversities and hospitals and industry and non-profit partners to improve the care of seriously ill, elderly patients andtheir families.

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Five Pillars and Six PrioritiesDefining a Canadian Wound Care Innovation Centre of Excellence

Delegates agreed that the CoE needed to have five pillars that would underpin its raison d’etre. These are (1)to serve as a concerted voice for the area of wound care; (2) to act as a bridge between industry, academia,health administrators, and policymakers; (3) to facilitate inter-professional collaboration on wound carerelated projects;(4) to develop and maintain human and educational resources in wound care and (5) toprovide a central repository of research data.

Economic impact

Besides improved value for money,a CoE would realize increasedpublic and private sector invest-ment in wound research and tech-nology.

With the creation of high-valuehealthcare jobs; stimulation ofwound care investment; and aninternational presence in the areaof wound care, Canada would be amore attractive businessenvironment for wound technologycompanies.

Clinical impact

Clinicians would be better servedby a CoE by having access toappropriate training, supports andstandards of practice; and to theright products and services at theright time.

Wound care providers wouldbenefit from the profile that a CoEwould bring to wounds as a nationalpriority issue.

The resulting impact would be de-creased healing time for wounds;prevention of first-time wounds;reduced hospital readmissions andfewer amputations.

Personal impact

A CoE dedicated to wounds wouldultimately benefit patients byadvancing innovation that leadsto faster healing and decreasedpain and suffering.

Many would avoid amputation oftheir feet and legs as aconsequence of advancedvascular disease.

Patients would see improvementsin their ability to self-careleading to increased motivationand an earlier return to normalactivities. Overall their quality oflife would improve.

A further plenary brainstorming session led to the following six priorities for the CoE - (1) to build a portfolio ofinnovative initiatives that support partnering between the academic, clinical, research and industry; (2) tocreate and maintain a national wound registry to standardize data collection; (3) to create and disseminatenationwide standards of wound care; (4) to coordinate research activities so that practice becomes grounded inevidence; (5) to raise professional and public awareness through educational initiatives and (6) to buildsustainability and renewal into the Centre’s agenda.

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Future-gazingAn exercise in imagining REAL possibilities

Delegates were asked to fast-forward seven years and imagine the Canadian Wound Care Innovation Centre ofExcellence has matured and is regarded as the gold standard for wound innovation. You’ve been asked to pres-ent at an international conference on how the CoE works and what has made it successful. Below is aconsolidated version of the responses.

Priority Future State

Partnerships

The Centre has built a portfolio of innovative initiatives that support collaboration between theacademic, clinical, research, patient, public policy and industry communities.The CoE has a reputation for providing pan-Canadian leadership and is recognized and respectedby all stakeholders.The Centre is a trusted advisor to governments on innovation in wound management and is thego-to source for wound care knowledge in Canada, especially on how to serve the First Nations,Inuit, northern and rural communities.

Wound RegistryThe Centre, in partnership with CIHI and CHI, created and maintains a national wound registry thatis linked to international wound registries.The registry is seen as the premier tool for enabling evidence-based wound managementresearch, analysis and evaluation.

Guidelines andStandards

The CoE facilitates and coordinates the development and dissemination of national standards,guidelines, protocols and performance benchmarks.The Centre is a repository for these guidelines and standards.

Research andAnalysis

The Centre is the clearinghouse for research activity in Canada.As an international hub for wound research, the Centre pools home-grown and internationalexpertise to deliver on a ground-breaking agenda.Working with CADTH and the various provincial health technology assessment agencies, theCentre has successfully promoted Canada as a leader in health technology assessment related towounds including health economic evaluations and quality-of-life studies.Global pharmaceutical, biotech, nutraceutical and device companies have set up R&D offices inCanada  as a consequence of the concentration of talent associated with the Centre.

Awareness andEducation

Wound management (prevention and care) is now a national and provincial priority issue.Patients, politicians and the public are aware of the magnitude of the problem.Investments in Canada’s wound innovation agenda are in alignment with the economic burden ofwounds.Health system managers have made wound care a big dot indicator.Canada’s research community has spearheaded a record number of studies about the impact ofskin breakdown and wound management.Policy makers are now attuned to wounds as an area requiring sustained effort.Media regularly cover stories related to wounds and wound management.The CoE is partnering to provide and accredit wound management education programs includingdissemination of evidence-based information about innovation in products, process and programs.

Sustainability

Canada is now the global leader for innovation in wound management and we are selling ourexpertise globally.Canada is a magnet for clinical trials, industry investment and jobs related to wound care.The Centre continually refreshes its agenda to meet the needs and expectations of its stakeholdercommunity and to remain relevant.Having received $25M from the federal NCE program, the CoE is leveraging this investment toensure the Centre’s long-term sustainability.

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The break-out sessions

During the afternoon, groups ofdelegates rotated between threediscussion stations to explore how aCanadian Wound Care InnovationCentre of Excellence could help meetcurrent needs in three areas - re-search, practice, and training.

Here are the high-lights of these break-out sessions.

On researchWound care is anarea with thepotential to yield“quick wins” inresearch and innovation.Many clinical care initiatives die outprematurely, while others duplicateearlier efforts. A CoE could avoid suchwastage by coordinating projectsthroughout the country and identify-ing those worthy of being deployed ona wider scale.

As a repository ofresearch data andpractice guidelines,the Centre would bein an excellentposition to compareproducts and caremodels in terms ofclinical and costeffectiveness.

The Centre can hold yearly meetingswith manufacturers to help themidentify projected market needs anddevelop market-aligned products.

The CoE’s research mandate shouldhave a disseminationcomponent thatincludes sharingindustry tools andshowcasing the work ofchampions to ensurewidespread use of thebest technologies.

Call to ActionRallying support

Canada has a national strategy for cancer prevention and control, astrategy for diabetes prevention and care, and the Canadian strokestrategy. These initiatives have demonstrated that investing in apan-Canadian approach can pay great dividends. For example, in 2000,the federal government provided $78 million to fund the Canadian

Stroke Network as a vehicle for reducing the burden ofstroke through leadership in research innovation. As aresult, we have seen several important advances in howstrokes are managed and lives are being saved. Themagnitude of the wound care epidemic calls for asimilar approach, centred around a national Centre ofExcellence (CoE).

Delegates to the Round-table meeting stronglysupported the rationale for a CoE and expressed an

active interest in helping to create it. We urgently call out to thebroader healthcare community to join the process. With the collectiveenergy of all stakeholder groups, political will and support, a CanadianWound Care Innovation CoE can become a reality and propel Canada toa position of global leadership in wound care.

Beyond developing an action plan for a CoE, Round-table participantsunanimously agreed that wound prevention and careshould become a priority area for the Council of theFederation Working Group on Health Innovation.Additionally, WCA Canada will recommend to thePublic Health Agency of Canada that non healingwounds be added to its list of major public healthchallenges.

WCA Canada has an innovation agenda for creatingefficiencies to transform service delivery. Solutions

include accelerating the development and uptake of best practice,measuring wound prevention and care outcomes, building knowledgecapacity within the provider workforce, and adopting innovation in pro-grams, products and processes. Continued and accelerated governmentinvestment in wound care innovation will help actualize these solutionswhile mitigating healthcare costs.

Wound care is an area of growing interest toclinicians, researchers, health care executives andmedical innovators. The time has come to harness thismomentum in the interest of our collective health andhealthcare system. With a CoE as the hub of anational wound care strategy, we can mobilizeCanada's best talent in the private and public sectorsand apply their discoveries to the task of advancingwound care while developing the economy andimproving the quality of life of Canadians.

As a progressive, health-focused nation, we have thecapacity to meet this challenge. We cannot afford toignore it.

“Wound care is all thebig health care agen-das – value for money,quality, safety, pa-tient-centredness, andevidence-based prac-tice .”

“We always end up in theproverbial pilot stage. We needa more permanent approach.”Nadine Henningsen, CanadianHome Care Association

“The Premiers are interestedin accountability andsustainability. The federalgovernment is interested ininnovation that improvesproductivity. Combining theseobjectives in a CoE makesgood sense.”Keith Denny, CanadianHealthcare Association

“Making wound care a big dotindicator would be agame-changer.”Ray Racette, Canadian Col-lege of Health Leaders

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More from the break-out sessions

On practiceThere is a need for a commonlanguage for measuring the incidenceand heal rates of wounds.Patient self-care is a crucialcomponent in the continuum ofwound care and should be included inclinical management pathways.

A CoE can serve as the clearinghousefor best practice and the first point ofcontact for stakeholders seekinginformation about wound careresearch and outcomes.

The CoE needs to have a strongpatient focus, including patientexperts and wound awarenessinitiatives. Funding models mustsupport prevention; there is a case tobe made for tying reimbursement inwound care to outcomes.

On trainingKnowledge transfer is hampered bythe lack of a feedback mechanism forevaluating outcomes.

The CoE must prioritize corecompetency programs for bothpractitioners and educators in woundcare; to this end, it could serve as anadvisory board for university trainingin wound care across a range ofhealth disciplines.

The development of wound carecertification – ideally at several levels– represents an excellent opportunityfor the CoE. The CoE could eithercreate its own certification programor partner with a larger health carebody to help wound care achieverecognition as a specialty; alongsimilar lines, the CoE could developand update CME programs thatinclude credit and study hours.

The CoE can play a leading role indeveloping wound care materials andresources, with a strong emphasis onprevention strategies.

Next StepsMoving forward

Several steps are needed to make a Canadian Wound Care InnovationCentre of Excellence a reality. Round-table delegates suggestedprioritizing the following action items for the next 12 months:

► Submit a brief to the Council of the Federation’s Working Group on

Health Innovation

► Make a submission to the Federal Standing Committee on Finance’s

pre-budget consultation

► Disseminate the Round-table report widely to all stakeholders

► Develop an innovative partnership model for next steps

► Initiate discussions with the Canadian Institute for Health Information

about publishing a report on wound care in Canada

► Confirm go-forward commitments from stakeholders

► Establish links to other national health professional organizations

► Identify anchor institution(s) and academic lead(s)

► Explore funding opportunities for the development of a business plan

► Pursue Canadian media to raise the profile of wound care in Canada

Round-table participants also agreed on the value of reconveningafter a year to review progress and develop a sustainable action planfor the longer term.

These steps, as well as the other insights and recommendations putforth in this report, represent the beginning of a consultative processthat welcomes input at all levels. As we proceed withimplementation, new directions and opportunities will arise. Themore people and perspectives drawn into the process, the better wecan shape and fine-tune the vision for the CoE and beyond. We inviteyou to join the conversation.

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References1. http://www.who.int/nmh/events/un_ncd_summit2011/3rd_plenary_meeting.pdf

2. 2010 “Ideas and Opportunities for Bending the Health Care Cost Curve Report” sponsored by the OntarioHospital Association (OHA), the Ontario Association of Community Care Access Centres (OACCAC) and theOntario Federation of Community Mental Health and Addiction Programs (OFCMHAP), p14; Ronald J.Shannon, MPH A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer Care in theOntario Community Wound Care Canada • Vol. 5, Suppl. 1; Based on 2009 Statistics Canada population data -Canada 33,700,000 Ontario 13,100,000 ; CIHI National Health Expenditure Trends, 1975 to 2011; Based onthese sources we can conservatively approximate the annual cost of wound care in Ontario at $1.5 billion.By extrapolation using population data, we further estimate that the annual cost of wound care in Canada is$3.9 billion or ~3% of total health expenditures.

3. http://www.rickhanseninstitute.org/en/information-about-sci

4. A. Hjort, MSc, MPP, Chief Financial Officer, Government of Greenland, Properties Agency INI, Sisimiut,Greenland; F. Gottrup, MD, DMSci, Professor of Surgery, Copenhagen Wound Healing Center, BispebjergUniversity Hospital, Copenhagen, Denmark. Cost of wound treatment to increase significantly in Denmarkover the next decade. Journal of Wound Care Vol 19, No 5, May 2010

5. The Smith & Nephew Foundation, “Skin Breakdown - The silent epidemic”

Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy, Chandan K. Sen,PhD, Gayle M. Gordillo, MD, Sashwati Roy, PhD, Robert Kirsner, MD, Lynn Lambert, CHT, Thomas K. Hunt,MD, Finn Gottrup, MD, Geoffrey C Gurtner, MD, and Michael T. Longaker, MD

6. OHA and OACCAC Report Four Pillars: Recommendation for Achieving a High Performing Health System June2011, p15

7. Knight L. Personal discussion re: visit volume and characteristics for Care Partners visiting nursing agenciesin the province of Ontario. 2004.

8. CAWC website: Prevalence of Chronic Wounds in Canada. GM Woodbury and PE Houghton

9. News Release. JUNE 8, 2010 (Release) Quebec City Cost of caring for stroke patients double that of earlierestimates, study finds

10. These principles were adapted from the CHSRF Provincial and Territorial Health System Priorities: AnEnvironmental Scan Brasset-Latulippe, Anne; Verma, Jennifer; Mulvale, Gillian; Barclay, Kevin 17/12/2011

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Our Partners and Supporters

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The Delegates

Dr. Bettina KlenklerOntario Centres of Excellence

Brenda MoodieMississaugas of the New Credit First Nation

Brian LewisMEDEC

Cathy HarleyCanadian Association for EnterostomalTherapy

Colin ZvanigaHealthoutcomes Worldwide

Danielle GilbertRegroupement Québécois en Soins de Plaies

David WhitesideHollister

Dawn Beaubien3M

Dr. Douglas QueenCanadian Association of Wound Care

Elise Rodd NielsenHealth Canada

Fabien PaquetteConvaTec

Gayle StuartHealth Quality Ontario

Harpreet BassiIvey International Centre for HealthInnovationWestern University

Janet DavidsonCo-chair

Jim BowenMcMaster PATH Research Institute

Sandra DudziakRevera

LCol Joel FillionNational Defence Canada

Dr. John SempleWomen’s College Hospital

John StoneHealthpoint

Karen WitkowskiTrillium Health Centre

Kathryn KozellAssociation of Canadian AcademicHealthcare Organizations

Dr. Keith DennyCanadian Healthcare Association

Kimberly BainBain Consulting Group

Lacey PhillipsAccreditation Canada

Laura TeagueOntario Woundcare Interest Group

Linda NortonCanadian Association of OccupationalTherapists

Lynn AbrahamMUI Scientific

Mark MattiCovidien

Mary McLeanMolnlycke

Maureen LatockiWound Care Alliance Canada

Nadine HenningsenCanadian Home Care Association

Rosemary KohrSt Elizabeth

Patricia McGarrCanadian Nurses Association

Peggy AhearnCanadian Association of Wound Care

Peter GardnerSmith & Nephew

Peter PichiniColoplast

Ray RacetteCanadian College of HealthLeaders

Rob StephenSystagenix

Rosemary HannamRotman Health SectorStrategy GroupUniversity of Toronto

Roslyn BairdSouthern Ontario AboriginalDiabetes Initiative

Shannon HandfieldVancouver Coastal Health

Shubie ChettyHealth Canada

Tom ClossonCo-chair

Voula ChristofilosDietitians of Canada

Gabrielle BauerMedical writer

Barbara TurnbullPatient advocate

SupportCeline Bryenton, CAWCDiana Seminara, CAWC

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For more information contact:

maureenlatocki@gmail.com