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Presence of one or more chronic wounds or ulcers of any etiology treated at a participating site using the wound-specific structured EHR or EDC system. Age: Any (including infants and adults 90 years or older, though reported in aggregate due to HIPAA). All patients and all wounds on all patients are enrolled so that there is no patient or wound selection bias.

This is a longitudinal, non-interventional registry study of chronic wounds and ulcers managed at hospital-based outpatient wound centers. Data collection began in 2005 and continues prospectively. Participating centers use structured clinical documentation tools within certified EHR or EDC systems to capture real-time, research-ready data during routine clinical care. Data from all patients are securely transmitted to the U.S. Wound Registry (USWR), which serves as a CMS-designated Qualified Clinical Data Registry (QCDR). As of the date of this update, the registry includes:

• - 226,913 patients.

• - 752,727 discrete wounds.

• - Data from 1,482 clinicians.

• - Participation from all 50 U.

S. states and Puerto Rico.The registry includes all types of chronic wounds and ulcers, including but not limited to:

• - Diabetic foot ulcers (DFUs) - Non-foot diabetic ulcers.

• - Venous leg ulcers (VLUs) - Arterial ulcers.

• - Pressure ulcers/injuries (PU/PI) on the torso and lower extremities.

• - Surgical wounds.

• - Traumatic wounds.

• - Vasculitic, sickle cell, inflammatory (e.g., pyoderma gangrenosum), and scleroderma-related ulcers.

Interventions tracked include a wide range of advanced wound care therapies, captured both by category and by brand where applicable. These include:

• - Advanced dressings (including collagen and antimicrobial dressings by brand) - Compression bandaging (by brand) - Off-loading devices (by brand) - Cellular and/or tissue-based therapies (skin substitutes, by brand) - Negative pressure wound therapy (by brand) - MIST therapy (low-frequency ultrasound) - Topical oxygen therapy (by brand) - Non-contact fluorescent imaging.

• - Topical growth factors such as becaplermin.

• - Enzymatic debridement agents including collagenase.

• - Various topical antibiotics and other treatments.

Wounds are risk stratified using the Wound Healing Index to support case-mix adjusted outcome analysis. Outcomes may occur at any time following enrollment and are captured longitudinally. Patients may be followed for over five years. The following outcomes are recorded:

• - Healed (fully epithelialized without drainage) - Not healed (persisting open ulcer) - Major amputation (above the ankle or wrist) - Minor amputation (below the ankle or wrist) - Lost to follow-up or transferred care.

• - Patient died.

Quality of care is assessed using wound-specific quality measures developed through the QCDR program. Registry participation supports regulatory reporting, including the registry option for Stage 2 of Meaningful Use and MIPS QCDR quality reporting. All registry data are managed by the U.S. Wound Registry (USWR), headquartered in The Woodlands, Texas. The U.S. Wound Registry (USWR) is recognized by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR). Participation in the registry supports regulatory initiatives such as the Merit-Based Incentive Payment System (MIPS) through the reporting of wound care-specific quality measures. These measures, developed and maintained by the USWR, are based on real-world care processes and outcomes derived from this registry. The USWR dataset may be linked to Medicare claims data through a secure tokenization process to support retrospective longitudinal analyses. This allows for the assessment of long-term patient outcomes including hospitalizations, readmissions, procedures, medication use, and mortality across care settings. The registry operates as part of a real-world evidence infrastructure and supports the principles of a learning healthcare system. By integrating quality reporting, research, and clinical care in a single data environment, the registry facilitates continuous learning and quality improvement at both the individual clinician and population levels.

Arms

: chronic wound cohort

Patients with one or more chronic wounds or ulcers receiving standard of care at hospital-based outpatient wound centers. Interventions are recorded as part of routine care and include advanced dressings, compression bandaging, off-loading devices, cellular and/or tissue-based products, negative pressure wound therapy, hyperbaric oxygen therapy, topical oxygen therapy, MIST therapy, enzymatic debridement (e.g., collagenase), antimicrobial and collagen dressings, and bacterial imaging. All interventions are recorded by brand when applicable.

Interventions

Other: - Usual care

advanced dressings, off-loading, venous ulcer compression, arterial screening