(PI-017) Standardizing Chronic Wound Care Using a Three-Phase Healing Model Integrated With Systemic and Local Impairment Drivers

• Chronic wound documentation is frequently fragmented, with emphasis placed on surface appearance and dressing selection rather than on underlying wound biology.


• Product-driven documentation obscures physiologic reasoning, weakens continuity between assessment and plan, and complicates demonstration of medical necessity.


• Chronic wounds fail to heal primarily because of unaddressed biologic barriers, not because of insufficient product use.


• A physiology-centered framework shifts documentation from “what was applied” to why an intervention is indicated based on wound phase and healing impairments.


• Organizing care around healing phases and systemic and local barriers improves clinical clarity, inter-provider communication, and regulatory defensibility.

• A structured documentation model was developed using two core components:




• Phases of Healing: Cleaning, Building, and Closing


• Healing Impairment Domains: Local and systemic factors affecting wound progression




• Providers classified each wound by its active biologic phase based on objective wound-bed findings.


• Local wound healing impairment factors (e.g., pressure, edema, infection) were identified and documented at each visit.


• Systemic wound healing impairment factors (e.g., perfusion, metabolic status, nutrition) were assessed and recorded.


• Clinical interventions were selected and documented based on:




• Active healing phase


• Identified local barriers


• Identified systemic barriers




• Documentation was evaluated for:




• Completeness


• Internal clinical logic


• Clarity of medical necessity

• Improved completeness of wound documentation, with consistent identification of both local and systemic healing barriers.


• Stronger physiologic alignment between assessment and plan, reducing phase–intervention mismatch.


• Clearer medical necessity justification for advanced therapies and procedural interventions.


• Reduction in redundant or incompatible dressing combinations driven by non-physiologic product stacking.


• Improved continuity of care across providers through standardized phase and barrier classification.

Chronic wound care is fundamentally a problem of impaired biology rather than product selection. When documentation and treatment planning are driven by dressing categories and wound types, physiologic drivers of delayed healing may be overlooked or insufficiently addressed. A framework organized around healing phase and impairment domains allows clinicians to document what the wound requires biologically rather than what is applied topically.

By structuring wound encounters around measurable biologic states and explicitly identifying local and systemic barriers, documentation becomes more consistent and defensible. Phase-based reasoning reduces therapeutic mismatch, supports sequencing of interventions, and strengthens provider communication. A physiology-centered model improves regulatory clarity by demonstrating that interventions are selected in response to identifiable biologic impairments rather than preference or routine.

This approach reframes chronic wound management as a dynamic process of biologic problem-solving rather than a static process of product selection, supporting consistent, transparent, defensible wound care.