Related Studies
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Barbara M. Bates-Jensen, Mary Cadogan, Jennifer Jorge, John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(9):1194-1202.
Pressure ulcers (PUs) are an important quality measure in nursing homes because they are common, often preventable, and associated with morbidity, mortality, and other quality of care problems. This paper describes nine quality indicators that reflect PU care processes determined by expert consensus to be related to positive outcomes (i.e., are valid) and feasible to implement in NHs. The quality indicators have been operationalized into a standardized system (link to puformsQI) that incorporates explicit measurement protocols and scoring rules. Indicator scores based on direct observation and medical record data for 191 residents in eight nursing homes are presented to illustrate how conclusions can be drawn about the quality of PU care using the indicators and standardized scoring system. The focus of the indicators on care processes that are under the control of nursing home staff makes the protocol useful for both external survey and internal quality improvement purposes.
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The Minimum Data Set Pressure Ulcer Indicator: Does it Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes?
Barbara M. Bates-Jensen, Mary Cadogan, Dan Osterweil, Lene Levy-Storms, Jennifer Jorge, Nahla Al-Samarrai, Valena Grbic, and John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(9): 1203-12.
This study showed that, despite assumptions to the contrary, nursing homes with low prevalence rates for pressure ulcers (PU) do not provide better PU care than homes with high prevalence rates. In general, all 16 nursing homes in this study performed poorly on screening and preventing PUs, though they did better at management once a PU was present.
The study examined 16 quality indicators related to PU care in two groups of nursing homes: Six homes with a high prevalence of PU and 10 with a low prevalence of PU. Prevalence of PU as reported in Minimum Data Set (MDS) resident assessments is a publicly reported quality measure for nursing homes. The assumption is that differences in prevalence rates reflect differences in quality of care. Thus, low PU prevalence homes are presumed to provide better care than high PU prevalence homes.
This study, however, found few differences between the two nursing home groups. Homes with low PU prevalence rates did not provide better care. Nursing homes with higher rates of PU, however, were more likely to use pressure-reduction surfaces and were better at documenting wound characteristics.
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The Effects of an Exercise and Incontinence Intervention on Skin Health Outcomes in Nursing Home Residents.
Barbara M. Bates-Jensen, Cathy A. Alessi, Nahla R. Al-Samarrai, and John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(3):348-355.
This randomized controlled study evaluated whether a combined exercise and incontinence intervention improved skin health outcomes for nursing home residents. Four risk factors related to skin health—urinary and fecal incontinence, physical activity, and skin wetness—did improve, but did not translate into significant improvements in most measures of skin health. There was no difference between the intervention and control groups in the incidence rate of pressure ulcers. However, those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area.
For the study, 190 incontinent residents in four nursing homes were divided into intervention and control groups. With intervention residents, research staff provided exercise and incontinence care every two hours from 8 a.m. to 4:30 p.m., five days a week for 32 weeks. The control group received usual care from nursing home staff.
The authors conclude that even if nursing homes had adequate staffing resources, they might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status.
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- Standardized Quality Assessment System to Evaluate Pressure Ulcer Care in the Nursing Home
- The Minimum Data Set Pressure Ulcer Indicator: Does it Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes?
- Effects of an Exercise/Incontinence Intervention on Skin Health Outcomes in Nursing Home Residents
Barbara M. Bates-Jensen, Mary Cadogan, Jennifer Jorge, John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(9):1194-1202.
Pressure ulcers (PUs) are an important quality measure in nursing homes because they are common, often preventable, and associated with morbidity, mortality, and other quality of care problems. This paper describes nine quality indicators that reflect PU care processes determined by expert consensus to be related to positive outcomes (i.e., are valid) and feasible to implement in NHs. The quality indicators have been operationalized into a standardized system (link to puformsQI) that incorporates explicit measurement protocols and scoring rules. Indicator scores based on direct observation and medical record data for 191 residents in eight nursing homes are presented to illustrate how conclusions can be drawn about the quality of PU care using the indicators and standardized scoring system. The focus of the indicators on care processes that are under the control of nursing home staff makes the protocol useful for both external survey and internal quality improvement purposes.
Back to Top
The Minimum Data Set Pressure Ulcer Indicator: Does it Reflect Differences in Care Processes Related to Pressure Ulcer Prevention and Treatment in Nursing Homes?
Barbara M. Bates-Jensen, Mary Cadogan, Dan Osterweil, Lene Levy-Storms, Jennifer Jorge, Nahla Al-Samarrai, Valena Grbic, and John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(9): 1203-12.
This study showed that, despite assumptions to the contrary, nursing homes with low prevalence rates for pressure ulcers (PU) do not provide better PU care than homes with high prevalence rates. In general, all 16 nursing homes in this study performed poorly on screening and preventing PUs, though they did better at management once a PU was present.
The study examined 16 quality indicators related to PU care in two groups of nursing homes: Six homes with a high prevalence of PU and 10 with a low prevalence of PU. Prevalence of PU as reported in Minimum Data Set (MDS) resident assessments is a publicly reported quality measure for nursing homes. The assumption is that differences in prevalence rates reflect differences in quality of care. Thus, low PU prevalence homes are presumed to provide better care than high PU prevalence homes.
This study, however, found few differences between the two nursing home groups. Homes with low PU prevalence rates did not provide better care. Nursing homes with higher rates of PU, however, were more likely to use pressure-reduction surfaces and were better at documenting wound characteristics.
Back to Top
The Effects of an Exercise and Incontinence Intervention on Skin Health Outcomes in Nursing Home Residents.
Barbara M. Bates-Jensen, Cathy A. Alessi, Nahla R. Al-Samarrai, and John F. Schnelle, 2003, in Journal of the American Geriatrics Society, 51(3):348-355.
This randomized controlled study evaluated whether a combined exercise and incontinence intervention improved skin health outcomes for nursing home residents. Four risk factors related to skin health—urinary and fecal incontinence, physical activity, and skin wetness—did improve, but did not translate into significant improvements in most measures of skin health. There was no difference between the intervention and control groups in the incidence rate of pressure ulcers. However, those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area.
For the study, 190 incontinent residents in four nursing homes were divided into intervention and control groups. With intervention residents, research staff provided exercise and incontinence care every two hours from 8 a.m. to 4:30 p.m., five days a week for 32 weeks. The control group received usual care from nursing home staff.
The authors conclude that even if nursing homes had adequate staffing resources, they might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status.
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