Meehan TP, Mathur D, Petrillo M, Lyder C; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presenter: Thomas P. Meehan M.D., M.P.H., Qualidigm, 100 Roscommon Drive, Middletown, CT 06457, Phone: (860) 632-6330, Fax: (860) 632-5865, e-mail: ctpro.tmeehan@sdps.org
Objectives: 1. to increase early identification of patients at risk for development of pressure ulcers; 2. to increase performance of processes of care designed to prevent pressure ulcers; 3. to decrease the incidence of hospital-acquired pressure ulcers; 4. to compare the impact of two quality improvement (QI) interventions: Rapid hospital improvement cycles and Peer Review Organization (PRO) performance feedback vs. PRO feedback alone.Study Design: State-wide intervention study with non-random assignment of interventions.Setting: Thirty-one acute care hospitals.Population Studied: Patients at risk of developing pressure ulcers were selected randomly by the PRO from each hospital's Part A Medicare claims indicating a principal discharge diagnosis of pneumonia, congestive heart failure, or stroke and a length of stay = five days. Chart abstraction was performed to assess inclusion (ambulatory impairment) and exclusion criteria (age < 65 years and stage II or greater pressure ulcers at hospital presentation). There were 3,367 patients identified in the baseline period (01/01/96-12/31/96) and 1,549 identified in the follow-up period (10/01/97-03/31/98). Main Process and Outcome Measures: Medical records were abstracted to assess performance of processes of care recommended in the Agency for Health Care Policy and Research Guidelines on Pressure Ulcer Prediction and Prevention and to assess pressure ulcer incidence. Interventions: All hospitals received written reports summarizing their performance relative to state-wide performance. Seventeen hospitals volunteered to conduct rapid improvement cycles (Plan Do Study Act) and to share their results with other volunteer hospitals.Principal Findings: Increases were noted in: identification of high risk patients (48.4% to 58.5%. p<0.001). Nutritional consults for malnourished patients (40.4% to 52.8%, p<001), and staging of acquired stage II pressure ulcers within two days of identification (22.2% to 43.0%, p<0.001). There were no aggregate decreases in process of care performance. Stage I pressure ulcer incidence increased (17.5% to 20.9%, p=0.02). When differences were compared between PDSA/PRO feedback and PRO Feedback Alone hospitals, significantly, greater improvements were noted in the PDSA/PRO Feedback hospitals. Use of pressure reducing devices increased by 1.2% in PDSA hospitals and decreased by 7.0% in Feedback Alone Hospitals (p<0.01). Repositioning of high risk patients every two hours increased 6.0% in PDSA hospitals and decreased by 14.4% in Feedback Alone hospitals (p<0.001). Moreover, the aggregate increase to stage I pressure ulcer development was explained by a 7.3% increase in Feedback Alone Hospitals in comparison to a 0.5% increase in PDSA hospitals (p=0.02).Conclusions: This state-wide QI project was temporally associated with increased identification of high risk patients and increased performance of preventive measures. An apparent increase in pressure ulcer incidence could have resulted from increased surveillance, improved documentation, or ineffective preventive interventions. Greater improvements were noted in hospitals conducting rapid improvement cycles and receiving PRO performance feedback vs hospitals receiving PRO feedback alone.Policy Implications: In order to maximize state-wide improvements in care, PROs will need to augment their usual audit and feedback of performance data with other interventions. Randomized controlled trials of potential QI interventions are needed to assess their true impact.Primary Funding Source: Health Care Financing Administration..
Publication Types:
Keywords:
- Hospitalization
- Hospitals
- Humans
- Incidence
- Medicare
- Pneumonia
- Pressure Ulcer
- Professional Review Organizations
- Risk Assessment
- economics
- methods
- hsrmtgs
Other ID:
UI: 102272654
From Meeting Abstracts