Why Some Wounds Heal and Others Don't: The Hidden Variable in Chronic Wound Care

Two wound care patients with identical clinical profiles. Same Wagner grade, same comorbidities, same nutritional status, same treatment protocol. One heals on schedule. One doesn't. The chart can't explain why — but new peer-reviewed research from MUSC, George Washington University, and UCLA¹ now can. The mechanism turns out to be something wound care teams have been watching for as long as wound centers have existed.

What the Wagner Scale Doesn’t Grade

Monday. 7:38 AM. The weathered workhorse pulls into the lot a few minutes ahead of her appointment, the way it always does. Meadowlark Yellow. Square-body. A symphony of steel, rust, and heritage. Mrs. Hazel Miller cuts the engine and sits for a beat before she opens the door. The truck ticks. Somewhere? A mourning dove coos. The water tower over by the highway catches the early light and goes the color of a brass button.

She climbs out of the cab. Carefully — right foot, then left, then the cane. The lot is half empty. A grain hauler on the frontage road downshifts and the sound carries clean across the flat. She tucks her purse under her arm and starts the slow walk toward the double doors proclaiming MERCY HOSPITAL WOUND HEALING.

Inside, Linda looks up from the front desk before the door has finished closing. "Morning, Miss Hazel." It’s not a question. It’s hospitality, recognition and it’s received, embraced. She's already pulling the chart. "Becca's gonna take you back in just a minute, honey — you want some coffee while you wait? Just made it."

Hazel takes the coffee. Two creams, no sugar. Proceeds to her chair — the one by the window where the morning sun comes in flat across the laminate floor. She sets the styrofoam cup on the little side table and folds her hands in her lap over the strap of her purse.

A local newspaper on the coffee table, three days old. A potted plant somebody waters faithfully. The framed photo of the chamber on the wall — somebody took it the day they opened, June 2011, ribbon-cutting and all — and the team is standing in front of it grinning like they collectively bought a Cadillac.

Becca pushes through the door from the back. Scrubs the color of a robin's egg. Stethoscope around her neck. Always.

"Miss Hazel." A smile. Real. "How was your weekend?"

"Quiet."

"Mine too. Karl took the boys fishin' Saturday, so I had the house to myself, which was a miracle." Becca laughs at her own line. "C'mon back, hon, let's get you settled."

Hazel pushes herself up on the cane. Becca doesn't reach for her — standing a considerate distance away, ready if needed. They walk back together. Pace? Slow. Becca matches. Respectfully.

The intake room? Small. Blood pressure cuff on the wall, scale in the corner, little rolling stool somebody bought from an office supply catalog ten years ago. Becca gestures to a chair and Hazel sits.

"Blood pressure, then we'll get your weight and walk back to the treatment room. Sound good?"

"Sounds fine."

Cuff goes on. The room is quiet enough to hear the soft hiss of the cuff letting down. Becca watches the gauge. Listens. Writes.

"One thirty-eight over eighty-two. Pretty good for a Monday." She unwraps the cuff. "Sugar this morning?"

"One twenty-six. Took my Lantus last night."

"Good girl." Becca catches herself, smiles. "Sorry — I mean ‘Good, good.’”

Hazel almost smiles back.

She steps on the scale. Becca records her weight without comment. She's been losing about a pound a month for the last six months. They both know it. No point in either of them pretending they don't.

"Alright Miss Hazel, let's walk on back."

Two doors down? An exam table, fresh paper rolled out. Wall-mounted light on a hinged arm. A rolling cart with supplies — saline, gauze, curved scissors. Wound camera plugged in on the counter, charging.

Hazel sits on the exam table and Becca helps her get her right shoe off. The shoe? A diabetic walker — black, ugly, Velcro straps. Hazel hates the shoe. Becca? Knows Hazel hates the shoe. Neither brings it up. The sock comes next. Carefully. Then? The wrap, gauze, contact layer, —

The wound.

Plantar surface of the right foot. First metatarsal head. About the diameter of a quarter. Granulation tissue at the base, some good, some not as good as Becca would like. A little drainage on the dressing — serosanguinous, not purulent, no odor. Five weeks in.

Becca measures with a disposable wound ruler making sure the date and patient identifiers are clearly legible. Takes pre-treatment photographs. Documents the condition. Hazel watches, the way she watches every Monday, with the same quiet attention.

"Looks about the same as last week, Miss Hazel. Maybe a hair smaller at the lateral edge."

"Mm."

"Dr. Brown's gonna want to talk to you about a couple things this morning. You doin' okay?"

"I'm fine, honey."

Becca pages Dr. Brown from the wall phone. Hangs up. Pulls a stool over and sits.

"Mind if I sit with you 'til he gets here?"

"I don't mind."

They sit together. The wall clock ticks. Somewhere down the hall, a printer warms up.

A knock at the door. Dr. Brown enters. A tablet under his arm and reading glasses pushed up into his hair. Mid-fifties. The kind of man who looks like he played catcher in high school. Never quite lost the build.

"Mornin' Missus Hazel!"

"Morning, Doctor."

He sets the tablet on the counter. Goes to the sink, washes his hands, dries them. Puts on Nitrile gloves. Then pulls the rolling stool up to the foot of the exam table.

"Can I take a look?"

"Mm-hm."

He runs his thumb along the lateral margin, gentle, watching the tissue respond. He presses lightly on the surrounding skin. Opens a cabinet and pulls out a disposable monofilament and tests sensation at four points around the ulcer.

“Becca can you navigate to the intake images?”

Becca uses her own tablet to helm the patient’s chart.

He looks at the foot in front of him. “Good, now can you navigate to the photos of just before we switched to the current contact layer? Hum.”

He leans back on the stool. Pushes his glasses down onto his nose. Looks at Mrs. Miller.

"Here's where I'm at, Hazel. We've been at this almost five weeks now. We've offloaded, debrided, tried Apligraf, and changed the dressing regularly. This wound? Is doing what stubborn non-healing wounds do — hanging on. It's not getting worse thankfully, but it's not on a healing trajectory either."

She knew this was coming. Has known for weeks.

"I'd like to bring in our Hyperbaric Oxygen Therapy Technician to talk with you about hyperbaric oxygen therapy, if you are okay with that? I think you'd be a good candidate, but I want you to hear what it’s like from somebody who runs the chamber every day. Then, if you're interested, I'll come back in and we'll talk through whether it's the right move clinically. Sound good?"

"What's it do?"

"Increases the oxygen your blood can carry and carries nutrients to your wound, which will allow your body to grow new blood vessels. But it's a commitment, and Marcus is gonna walk you through what that looks like better than I can."

She ponders. Looks at her foot. Looks back at him.

"Alright."

"Good." Standing Dr. Brown takes off his gloves, washes his hands, and retrieves his tablet. "Let me get your chart updated. Becca, can you re-wrap Missus Miller’s wound and go grab Marcus?"

Becca nods, rewraps the foot. Same careful order in reverse — new contact layer, gauze, the wrap, the sock, the walker shoe and steps out. Dr. Brown finishes his charting and gives Hazel a reassuring smile, “I'll be back in a bit,” as he follows Becca down the hall shutting the door gently.

Another knock. The door opens. "Mrs. Miller? Marcus." Late forties. CHS embroidered on his ceil blue scrubs.

He pulls up the rolling stool Dr. Brown just vacated and hands her a folded patient guide.

"Doc Brown tells me he'd like to get you set up for HBOT. Mind if I walk you through what that looks like?"

"Sure."

"Alright. Just a couple of quick questions for you. Have you ever had a collapsed lung? Or heard one of your doctors mention a Pneumothorax?"

"No."

"Good. What about a pacemaker, defibrillator, any metal implants? Pumps for anything?"

"Just my hip. The right one. Back in 2017."

"That's fine. How 'bout medications — anything new since you saw Dr. Brown last?"

"No. Just my Lantus and the metformin and the blood pressure pill."

Marcus nods. Doesn't write anything down. Reads her face for a beat. "How are you with tight spaces?"

She considers. "I had an MRI few years back. Did okay."

"So the chamber is actually bigger than an MRI. The whole thing, sans the ends, is acrylic glass. So you can see right out and watch TV or listen to music if you’d like to. Honestly? Most folks take a nap."

He lets that sit.

"So here's what a treatment actually feels like. You'll change into cotton scrubs — we provide those, no jewelry, no lotions, no electronics. You lay on a gurney, I’ll slide you in, and pressurize the chamber slowly. Takes about 15 minutes to get to pressure. Only thing you'll really feel is in your ears. It’s kinda like flying, or like driving up in the Rockies. We’ll teach you a couple ways to clear 'em — pinch your nose and blow gentle, or just swallow. Then you’ll be at pressure for ninety minutes. I’ll check in with you every couple of minutes through an intercom and be right there with eyes on you. Then it’s 15 minutes back to surface pressure. If you ever feel uncomfortable? You can ask to come up early if you need to. Although we do our best to help in any way we can."

Hazel nods slowly.

"Now I'm not gonna downplay the schedule for you. Treatments are five days a week, Monday through Friday, for about four to six weeks give or take. Just depending on Doc’s orders. Could take as few as twenty treatments or as many as sixty to get a wound like yours where it needs to go. Each treatment is about two hours, plus check-in, changing into scrubs, and check-out — so figure two and a half, three hours from when you walk in the door 'til when you walk out. Plus driving in from the home place. It's a real commitment, Mrs. Miller, and I won't pretend it isn't."

"Mm."

"Some folks try it out and they realize after a week they can't make the drive five days a week. That's a real conversation I’ve had in the past. So, if it's not gonna work for your lifestyle, better to know now than three weeks in."

"I can make the drive."

"Alright. That's good! What questions have you got for me?"

Hazel looks at her foot. Looks at the folded patient guide laying on the exam table. Looks back at Marcus.

"Does it work?"

He's got thirty treatment stories he could tell her right now but doesn’t.

"Miss Hazel, I'm gonna answer you this way. You ever kept a houseplant?"

"Sure."

"You water it, give it sunlight, plant it in good soil — what happens?"

"It grows."

"What happens if you stick it in a closet, never water it, and let the cat use the pot?"

She cracks a smile. "It dies."

"Right. Your foot? That’s the plant. Right now we've been waterin' it and givin' it good dirt — that's the dressings, offloading, and what Dr. Brown and the wound care staff have been doing. But right now? The roots aren’t taking. They need oxygen. It's not magic — it's just givin' your body what it's been askin' for. What do you think? Interested?"

Hazel looks at him for a long second. Something settles in her face.

"Sounds good, Marcus. But can I see the chamber before I commit?"

Marcus stands. Tucks the stool back. "Sure! Let me go grab Doc Brown, he'll come back and walk you through the particulars."

"Sounds good."

He gives her a small nod. Steps out. Pulling the door closed gently behind him.

A knock. Dr. Brown and Becca are back.

"Alright Missus Hazel. Sounds like you're interested?"

"I am."

"Good. I think that’s the right call. Few things on my end, then we'll get you on the schedule."

He pulls the stool back to the foot of the table. Sits. He glances at Becca, who has the chart open. "No history of pneumothorax, no implants we need to worry about, current meds are Lantus, metformin, and the lisinopril, correct?"

"That's right."

"Okay, good. The other thing — and Marcus probably already told you this — this is a four to six-week-ish commitment, five days a week. I want to make sure you've thought about the drive and time drain. It's a big ask."

"I've thought about it."

"Anybody at home helping you?"

A pause. "My daughter calls Sundays. From Wichita."

"Okay. Anybody local who can run you up if you have a day where the truck won't start or you're not feeling up to drivin'?"

"There's a girl from church who helps me with groceries. I could ask her?"

He nods. Picks up the tablet. Sets it down again.

"One more thing. Hyperbaric oxygen is safe, but it's a medical treatment and has its inherent risks. Ear barotrauma — pressure injury to the eardrum that is — is the most common, and Marcus is gonna teach you how to clear your ears so we minimize that. Rare risks include changes in vision that usually return to normal a few weeks after treatment ends. So, don’t go get your glasses changed before the end of treatment, okay? And finally, very rarely, an oxygen-related seizure happens during a treatment session. Marcus will be monitoring you for all of it. I'm telling you this because you're going to sign a consent form here in a second that lists all the adverse reactions and I want you to hear it from me first."

"I appreciate that."

"Any questions for me?"

"How long until I'd know if it's working?"

"Good question. Most patients see a meaningful change in their wound by treatment fifteen, sometimes earlier. We photograph and measure every week — the same as Becca's been doing during your weekly wound care appointments — so we’ll have data, not guesses. If we're not seeing any improvement? We can have a conversation about whether to continue."

"That sounds fair."

"Alright. Becca's gonna get the consent paperwork going. Marcus is going to come back and walk you over to the chamber room so you can see the setup before you leave today. Sound good?"

"That sounds fine."

Dr. Brown stands. “I’ll see you at your next appointment. Safe travels on the way home, okay? They’re saying it might rain this afternoon.” He tucks the stool back in and crosses paths with Becca as she brings in the consent form.

"Here you go Miss Hazel. Sign this for me if you will..."

Marcus comes back and they walk down the hall together — Hazel on the cane, Marcus at her pace, neither of them filling the silence.

The chamber room is at the end of the hall. He holds the door open for her.

The chamber sits in the middle of the room. Transparent. Cylindrical. Steel. A flat-screen TV mounted on a swing arm. A folded blanket on the gurney. A pair of cotton scrubs draped over the back of a chair, ready for whoever's next.

Hazel stops in the doorway. Scrutinizing. Marcus lets her.

"Bigger'n you thought?"

"Some."

"Folks always say that. Come on in, I'll show you the inside."

He walks her to the chamber. Opens the door. The acrylic catches the overhead light and throws a soft band.

"So, you'll lay here. Pillow under your head, of course. Blanket if you want one. I'll close this end, pressurize you slow, just like we talked about. When you're at depth you'll feel about the same as you do right now — just a little fuller in the ears. Ninety minutes, then you’ll come back up. And that's it."

She doesn't say anything.

"You want to sit on it?"

"...Yeah."

He helps her up onto the gurney. Not into the chamber, just sitting on the edge of the gurney. Her feet hang. Just like sitting on the tailgate of an F-150.

"Tomorrow we'll do the real thing. After that you'll know what to expect."

"Tomorrow."

"Yes ma'am. Eight AM if that works for you. I'll be right here in the morning."

She nods. He helps her down. They walk back to the front together, slower than they walked in. Becca gives some words of encouragement and a pat on the shoulder in transit between patient rooms. Linda has an appointment card filled out for the morning timeslot and hands her a fresh cup of coffee for the road. "You drive safe, Miss Hazel."

"I will, honey."

Marcus is at a desk engaged in paperwork. He looks up.

"See you tomorrow, Mrs. Miller."

"See you tomorrow, Marcus."

Beyond the Dressing: The Hidden Biology of the Patient

Wound care teams have always intuitively known that the patient matters just as much as the wound.

In April of this year, a team led by Teresa Kelechi, PhD at the Medical University of South Carolina, with collaborators at George Washington University and UCLA, published a paper¹ in Advances in Skin & Wound Care that put a measurable biological mechanism behind what wound care teams have been seeing for years. The finding is simple, but the implications are not: patients with chronic leg and foot wounds who report higher levels of loneliness show significantly elevated expression of pro-inflammatory genes — the exact genes that need to switch off for a wound to heal.

The Social Genomics of Wound Care: Behind Teresa Kelechi’s 25-Year Loneliness Study

Kelechi's path to her and her team’s findings started the way most wound care insights start: a patient's stalled wound.

About twenty-five years ago, she had a patient whose wound wasn't responding to standard wound care. Everything on the clinical side checked out — clean wound bed, no infection, good nutrition, the right dressings, appropriate offloading. "All the things that would make people heal," she told South Carolina Public Radio in May.² "However, there was something missing that we could never put our finger on."

The patient told her himself: you need to be studying loneliness.

So, she did. For twenty-five years.

The April 2026 paper¹ is the one that put numbers behind the observation. Kelechi partnered with Laurie Theeke, PhD, at George Washington University — a loneliness-and-health researcher with fifteen-plus years in the field — and Steven Cole, PhD, at UCLA, who developed the Conserved Transcriptional Response to Adversity, or CTRA. Cole's framework describes a specific pattern of gene expression changes that occurs in response to chronic social stressors. Loneliness is one of those stressors. So are social rejection, low socioeconomic status, bereavement, and a handful of others. The body interprets prolonged social adversity as a threat state and adjusts gene expression accordingly. Inflammatory genes get turned on and antiviral genes get turned down. The immune system shifts from healing-mode to defense-mode and stays there.

Kelechi's team applied CTRA to thirty-eight patients with chronic lower extremity ulcers and utilized the UCLA Loneliness Scale, a validated screening tool, to measure each patient's loneliness. The 20-item questionnaire distinguishes higher-loneliness (score ≥40) from lower-loneliness (score ≤39) patients. They drew blood at baseline and again at four-week follow-up while patients were receiving wound care. Then, whole blood RNA sequencing told them which genes were active and which weren't.

The higher-loneliness group showed significantly elevated expression of pro-inflammatory genes—at both baseline and again four weeks later (P = 0.010). The pattern was robust when controlling for depressive symptoms (so it isn't just depression in disguise) and robust when controlling for variations in leukocyte subset proportions (so it isn't an artifact of which immune cells happened to be in the blood sample). Wound healing was also independently associated with elevated inflammatory gene expression (P = 0.025), as was self-reported wound pain (P = 0.018).

Translation for wound care teams: the lonelier patients weren't just feeling worse. Their bodies showed the inflammatory gene expression pattern that interferes with wound closure.

Loneliness vs. Social Isolation: Why Headcounts Mislead Wound Care Teams

Loneliness, as defined by the U.S. Surgeon General in his 2023 advisory on the topic,³ is the subjective perception of feeling alone or disconnected from others, regardless of the amount of social connections. A patient with three living children and an accessible church directory can be lonely, while a patient who lives by herself with a routine she likes and a dog she talks to can be content. The UCLA scale measures perceived disconnection — not headcount.

This matters operationally because the wound clinic team is going to misread a lot of patients if they're scanning for isolation. The widowed patient who drives herself to clinic and lives alone may have an active social circle outside your walls and feel completely connected. The patient who arrives with a daughter and a grandson at every visit may be the one whose gene expression is firing the inflammatory pattern. You can't tell from across the room.

The operational failure mode is subtle. A wound care team trying to do right by their patients will naturally reach for the social data the intake already captures — lives alone, widowed, no family nearby, no transportation. Those fields feel like loneliness markers. They’re not. They're isolation proxies, and isolation isn't what Kelechi's team measured. The patient whose chart shows a spouse, two adult children, and a full emergency contact field can still cross the UCLA high-loneliness threshold — and if the team is screening by chart review instead of by asking, that patient gets missed. The only way to find them is the same way Kelechi found them: a validated instrument administered directly to the patient.

The Future of Wound Therapy: Treating Loneliness as a Clinical Intervention

The Kelechi team has a follow-up study pending — a randomized trial that would deliver individual cognitive behavioral therapy to wound clinic patients to address loneliness, with gene expression measured before and after the intervention. "We can change gene expression in as little as three months," Theeke told MUSC News in April.⁴ The question the trial is designed to answer: if a patient’s loneliness is treated, does the inflammatory profile shift? And if it does — does a chronic, non-healing wound finally close?

While the research team acknowledges that thirty-eight patients is a small pilot cohort and the larger randomized trial is still pending, the underlying mechanism remains highly plausible: psychosocial state → gene expression → inflammation → impaired healing. A screening tool exists and an intervention pathway is being built.

The U.S. Surgeon General's 2023 advisory adds further context on the topic. About half of U.S. adults report measurable levels of loneliness.³ The mortality risk from lacking social connection is comparable to smoking up to fifteen cigarettes per day.³ The CDC has a dedicated page on the health effects of social isolation and loneliness, listing increased risk for heart disease, stroke, type 2 diabetes, depression, anxiety, and earlier death.⁵

Operationalizing the Data: What Social Genomics Means for Wound Care Leaders

The Kelechi paper hands a key to a door that wound care leaders have been standing next to for a long time without knowing it was there.

Patients walking into a wound clinic for chronic non-healing wounds are the same population at elevated risk for the loneliness profile Kelechi’s paper measured. Older adults. Patients with multiple chronic conditions. Patients whose mobility limits their social radius. Patients whose spouses have passed and whose adult children live two states away. A patient’s medical record, in theory, flawlessly captures wound surface area, tissue granulation, and exudate levels—but it completely misses the social environment driving those metrics.

SHS Insight: A wound care or HBOT program that sees the same patient between one to five days a week for four to six weeks or more is not just delivering advanced clinical modalities. It is systematically delivering the sustained human contact required to down-regulate a patient's pro-inflammatory genetic expression. That mechanism is structural, not incidental. The question is whether wound care programs are set up to recognize, document, and support it.

Implementing the UCLA Loneliness Scale: Low Barrier, High Operational Value

The UCLA Loneliness Scale is not only available in the 20-item version, which was utilized in the Kelechi study, but also in a condensed 3-item version that has been validated for primary care and chronic disease populations. The 3-item UCLA Loneliness Scale uses three simple questions scored on a 4-point scale.⁶ A total score of 6 or above quickly flags a patient as lonely, translating a 20-item abstract metric into a fast, 60-second rooming protocol. It’s free, does not require an additional licensure to administer, and produces a score that can be documented just like any other validated assessment.

The reason to bring it into a wound care intake is not to add a service line. It’s to give your wound care team a measurable variable for something they have always been reading intuitively. A patient whose UCLA score crosses the high-loneliness threshold is not a different kind of patient — they are the same patient the team has been working with, now with a documented marker that may correlate with their wound's behavior over the course of their treatment.

For programs operating in CMS value-based care environments, validated psychosocial screening also fits the broader Social Drivers of Health (SDOH) screening direction CMS has been moving toward across inpatient and outpatient settings.⁷ Documenting loneliness screening, the score, and any referral or intervention pathway is consistent with where the regulatory environment has been heading.

For wound care programs offering HBOT, the loneliness screen may also function as an early behavioral health flag. Patients entering a 20+ session course of pressurized, high-oxygen treatment benefit from upstream identification of psychological distress — and the wound care team is often positioned to catch it earlier than any other provider in the patient's care continuum.

Building the Referral Infrastructure: Loneliness as a Specialist Consultation

Screening for loneliness without a referral pathway, however, isn't really screening at all — it's documentation theater. A wound care program that identifies a high-loneliness patient and then has nowhere to send them has created a documentation problem and a clinical concern without solving anything.

This is where program design matters, and the logic is already familiar to wound care leaders. If a patient presents with an uncontrolled heart murmur, a dangerous A1C spike, or a blocked peripheral artery, the wound team doesn’t try to treat it themselves—they route them to cardiology, endocrinology, or vascular surgery. They document the complication and issue a referral.

Loneliness requires the same operational playbook. A wound clinic does not need to become a behavioral health clinic or a social work agency. The wound clinic’s job is to recognize, document, and route to the appropriate behavioral and community specialists.

While the Teresa Kelechi research team is currently developing an in-clinic Cognitive Behavioral Therapy (CBT) protocol, most programs right now must build strong external referral networks. This means knowing exactly who in your healthcare system or local community handles the next step:

• Systemic Navigation: The hospital's internal care management or social work teams.

  
  

• Digital Health Tools: Patient-facing platforms like AARP Foundation's Connect2Affect, which offers a self-assessment, educational resources, and a searchable directory of local programs patients can engage with between visits.

  
  

• Community Infrastructure: Local Area Agency on Aging programs, faith-based volunteer networks, and local senior community centers.

The job of the wound team is not to single-handedly cure an epidemic of social isolation. The job is to stop treating the wound in a silo and route the patient to the specialists who can.

SHS Perspective

The Shared Health Services team has worked directly with our partner wound care and HBOT program staff for over 30 years. During that time, our pre-survey audit reviews — Strategic Ten-Point Audit Reviews (STAR) — have repeatedly surfaced the same observation across geographies: a meaningful percentage of wound care and HBOT patients describe their clinic visits as the most consistent human contact in their lives, particularly during HBOT treatment courses with daily attendance.

For a patient like Miss Hazel, four to six weeks of hyperbaric oxygen therapy provides vital fuel to the physical wound. But walking through those clinic doors five days a week to hear a friendly 'Morning, Miss Hazel' from people who truly see her? That might be the very intervention that shifts her gene expression from inflammation back toward healing mode.

Our role isn't to add a screening line item to your intake. It’s to help your program recognize that inflammation-reduction work your team is already performing, document it in ways that satisfy shifting CMS quality mandates, and build a workflow infrastructure — screening integration, referral pathway development, audit-ready documentation — that protects the value your team has already created.

For partners thinking through how to operationalize the Kelechi findings, the first questions are usually the right ones:

• Does your current intake workflow have capacity for a brief validated screening tool?

  
  

• Do you have documented referral pathways for psychosocial concerns identified during wound care?

  
  

• Does your team document the social context observations they are already making, or do those observations stay verbal?

These are the conversations our STAR visits and consulting engagements are custom-built to address.

Marcus will be there at 8 AM. So will Becca. So will Linda. So will Dr. Brown. So will the chamber. So will Miss Hazel.

Wound care teams have been doing this work for as long as wound programs have existed. The biology is just finally catching up and documentation requirements will follow suit. The wound care team's job? Just like it always has been, is to keep doing the work in front of them — one wound, one patient, one Monday morning at a time.

References:

1. Kelechi TJ, Cole SW, Theeke L, Mueller M, Hanley ME, Visserman JJ, Madisetti M, Muise-Helmericks R. Use of a Social Genomics Model to Explore Loneliness and Systemic Inflammation in an Adult Population With Chronic Lower Extremity Ulcers. Adv Skin Wound Care. 2026;39(3):159-167.

   
   

2. South Carolina Public Radio Health Focus. Loneliness and wound healing research. Interview with Teresa Kelechi, PhD. May 12, 2026. https://www.southcarolinapublicradio.org/show/health-focus/2026-05-12/loneliness-and-wound-healing-research

   
   

3. Office of the Surgeon General (OSG). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. Washington (DC): US Department of Health and Human Services; 2023. PMID: 37792968. Bookshelf ID: NBK595227. https://www.ncbi.nlm.nih.gov/books/NBK595227/

   
   

4. Glorioso K. Linking loneliness to inflammation in wound care. MUSC Research News. April 2, 2026. https://research.musc.edu/content-hub/News/2026/04/02/linking-loneliness-to-inflammation-in-wound-care

   
   

5. Centers for Disease Control and Prevention. Health Effects of Social Isolation and Loneliness. CDC Social Connection. https://www.cdc.gov/social-connectedness/risk-factors/index.html. Accessed May 14, 2026.

   
   

6. Centers for Medicare & Medicaid Services. Social Drivers of Health and Health-Related Social Needs. CMS Priorities & Innovation. https://www.cms.gov/priorities/innovation/key-concepts/social-drivers-health-health-related-social-needs. Accessed May 14, 2026.

   
   

7. Hughes ME, Waite LJ, Hawkley LC, Cacioppo JT. A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Res Aging. 2004;26(6):655-672. PMID: 18504506. PMCID: PMC2394670. doi:10.1177/0164027504268574