Sponsored: Carisk Partners
Addressing Physical & Emotional Injury: A Case Study Supporting the Evidence-Based Approach to Wound Management
Meeting the needs of a patient with chronic or acute wounds requires care beyond convention, including a multidisciplinary approach, specialized treatment, and comprehensive surgical and non-surgical interventions. Wound management can be complicated by psychosocial risk factors such as anxiety, depression, and/or post-traumatic stress disorder, where each emotional injury (often in combination) requires as much care and attention as the physical wound.
Proper wound management calls for a program that combines specialized medical and mental health disciplines, expertise in managing the toughest clinical cases and often with the most challenging patients to reach and activate; this requires responsive, quality care that focuses on addressing the depth of any mental health damage, along with the depth of the patient’s tissue damage.
A specialized program developed by Carisk® Partners incorporates an understanding of evidence-based medical and behavioral health practices in wound management and addresses the full spectrum of challenges often seen in wound care cases. Carisk recognizes the complexity of all of the biopsychosocial variables involved with individual injuries requiring wound management. As illustrated in the following case study, the Carisk Wound Management Program meets individual patients and their unique needs right where they are in their journey. The program, which is embedded into Carisk’s existing Pathways™ 2 Recovery program, delivers on all of the hallmarks of Carisk’s distinctive approach that their clients have come to appreciate and expect: science-based medical expertise, strengths-based patient engagement, empathy-based care navigation, and outcomes-based Care Coordination Plans.
“When a patient is recovering from physical wounds, it’s important to remember that they are often attempting to heal from emotional injury as well. Attention to one, without the other, dramatically increases the medical and the mental health risks for that individual.”
– David Vittoria, Senior Vice President, Clinical Business & Product Development at Carisk Partners
The Case of Corey
Corey is a young man who sustained an L1 spinal cord injury while at work in 2017, resulting in paraplegia. Corey was referred to Carisk two years following his initial injury, after experiencing significant delays in recovery due to the nature of the physical and emotional challenges he was experiencing. At the time of referral, Corey presented with multiple stage 4 pressure injuries with diverting colostomy, three failed flap procedures and osteomyelitis (inflammation or swelling that occurs in the bone as a result of an infection). His wound recurrence was secondary to non-compliance and presented a significant risk, as infection is the leading cause of hospitalization and mortality in this patient group.
Especially notable in Corey’s case was the difficult emotional journey he was experiencing. Initially, Corey was extremely reluctant to open up and engage with the assembled care team. He was disengaged, hopeless, sad, suicidal, angry, resistant, anxious, and using substances. Through weeks of building trust and engagement with the Clinical team, Carisk would come to learn that there was a history of domestic disputes and arrests which led to Corey, his wife and their small child being kicked out of family members’ homes, hotels, and motels where they were staying. Corey was non-compliant with his physical therapy and other rehab treatment, with access to reliable transportation being one of the many barriers. He had been abusive to hospital staff, eventually being asked to leave a rehabilitation center of excellence due to his behavior. Much of this was a replay of aspects of his traumatic, abusive childhood and became a significant factor contributing to delays in his recovery.
Corey’s Pathway 2 Recovery
“Through development of the Carisk Wound Management Program, we have further expanded the Pathways 2 Recovery program, including adding to our medical and mental health team expertise, focusing our patient clinical interview, and augmenting our systems and technology by way of data capture, analysis and documentation. The result is a program that recognizes the unique needs of patients with wounds, powered by key data mining, expert guidance and patient partnership.”
– Alana Letourneau, MD, MBA, Chief Clinical Strategy Officer at Carisk Partners
The Carisk Pathways™ 2 Recovery Program was created for cases like Corey’s. Through the bond Corey and his multidisciplinary team forged, Carisk helped him to enact positive changes and reframe his perceived threats as opportunities. He stopped using substances, benefited from anger management coaching, reduced his anxiety and depressive symptoms, processed his trauma related to the accident, improved his marriage, and became a better father to his young daughter.
The psychosocial interventions in this case were key to enabling effective medical interventions. Carisk assisted in smoking cessation prior to Corey’s fourth flap procedure; the procedure was followed by antibiotics, wound care and infectious disease oversight. Corey was provided a wearable device- a remote watch- to assist in offloading reminders. Referrals to Urology and GI were facilitated for neurogenic bladder and bowel oversight. The Carisk clinical team paired Corey with a nutritionist, connected him to housing assistance and coordinated transportation to all appointments.
Over time, Corey was matched with behavioral health support, including a psychiatrist, mental health counselor and a pain management specialist to help transition him from opioids to suboxone. With proper psychosocial support in place, Carisk was able to get Corey to a place where he was motivated to complete outpatient physical therapy and rehabilitation through a home program, followed by a gym membership coordinated by Carisk.
Where is Corey now?
Corey’s experience was coordinated by a team whose activities centered around information gathering, understanding his personal viewpoint and forming a relationship built on empathy-based care navigation, sensitivity and trust.
Corey’s clinical outcomes included resolution of osteomyelitis without infection recurrence during the period of Carisk’s management over two years. Corey’s fourth flap procedure was successful, without need for further revision. He completed his rehabilitation course and was offered a job at the gym he attended. Functionally, Corey achieved independence in self-care and modified independence in mobility. Corey stated that his goal was to walk into the hospital where he was treated following his acute injury. At present, this goal is a reality, as Corey is able to stand and ambulate with the assistance of durable medical equipment.
Previously too ashamed to smile, Corey today finds himself smiling frequently – both due to his current fulfillment in life and also secondary to the dental work that restored his fractured smile following the accident.
Carisk recognizes how important it is to invest equal attention to the whole patient and their lived experience, being attuned to patient and family perceptions and expectations of care, all of which drive engagement, activation, trust, and timely wound healing. Ultimately, it’s not just the physical aspects of the healing process that patients must face but also the deeper psychological problems that can surface. Delivering on a patient-centered, specialized wound care program is key to patient recovery and improved outcomes.
To learn more about the Carisk Wound Management Program, please reach out to Thomas Downey, EVP Sales, [email protected] or visit www.cariskpartners.com.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Carisk Partners. The editorial staff of Risk & Insurance had no role in its preparation.