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Quality of Care for Hospitalized Medicare Patients at Risk for Pressure Ulcers
Courtney H. Lyder, ND;
Jeanette Preston, MD, MPH;
Jacqueline N. Grady, MS;
Jeanne Scinto, PhD, MPH;
Richard Allman, MD;
Nancy Bergstrom, PhD;
George Rodeheaver, PhD
Arch Intern Med. 2001;161:1549-1554.
Background No state peer review organization has attempted to identify processes
of care related to pressure ulcer prediction and prevention in US hospitals.
Objective To profile and evaluate the processes of care for Medicare patients
hospitalized at risk for pressure ulcer development by means of the Medicare
Quality Indicator System pressure ulcer prediction and prevention module.
Methods A multicenter retrospective cohort study with medical record abstraction
was used to obtain a total of 2425 patients aged 65 years and older discharged
from acute care hospitals after treatment for pneumonia, cerebrovascular disease,
or congestive heart failure. Six processes of care for prevention of pressure
ulcers were evaluated: use of daily skin assessment; use of a pressure-reducing
device; documentation of being at risk; repositioning for a minimum of 2 hours;
nutritional consultation initiated for patients with nutritional risk factors;
and staging of pressure ulcer. The associations between processes of care
and incidence of pressure ulcer were determined with Kaplan-Meier survival
analyses.
Results National estimates of compliance with process of care were as follows:
use of daily skin assessment, 94%; use of pressure-reducing device, 7.5%;
documentation of being at risk, 22.6%; repositioning for a minimum of 2 hours,
66.2%; nutritional consultation, 34.3%; stage 1 pressure ulcer staged, 20.2%;
and stage 2 or greater ulcer staged, 30.9%.
Conclusion These results suggest that US hospitals and physicians have numerous
opportunities to improve care related to pressure ulcer prediction and prevention.
From Qualidigm, Middletown, Conn (Drs Lyder, Preston, and Scinto and
Ms Grady); Section of Geriatric Nursing, Yale University School of Nursing,
New Haven, Conn (Dr Lyder); University of Connecticut Center on Aging, Farmington
(Dr Preston); Section of Geriatric Medicine, University of Alabama School
of Medicine, Birmingham (Dr Allman); University of Nebraska Medical Center
College of Nursing, Omaha, and University of Texas–Houston, Health Sciences
Center, Center on Aging (Dr Bergstrom); and Department of Surgery, University
of Virginia School of Medicine, Charlottesville (Dr Rodeheaver).
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