National Healthcare Quality and Disparities Report
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- Comparative Effectiveness (1)
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- (-) Pressure Ulcers (11)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedMilliren CE, Ozonoff A, Fournier KA
Enhancing pressure injury surveillance using natural language processing.
This study’s goal was to assess the feasibility of using nursing handoff notes to identify underreported hospital-acquired pressure injury (HAPI) events. The authors established a natural language processing-assisted manual review process and workflow for data extraction from a corpus of nursing notes across all medical inpatient and intensive care units in a tertiary care pediatric center. Their workflow started with keywords around HAPI and treatments, then regular expressions, distributive semantics, and finally a document classifier. They generated 3 models: a tri-gram classifier, binary logistic regression model using the regular expressions as predictors, and a random forest model using both models together. Their final output was generated using a random forest model validated using derivation and validation sets. Their initial data set involved 70,981 notes during a 1-year period from 5484 unique admissions for 4220 patients. Their interrater human reviewer agreement on identifying HAPI was high. Their random forest model had 95% sensitivity, 71.2% specificity, and 78.7% accuracy. A total of 264 notes from 148 unique admissions were identified describing likely HAPI, with 61 describing new injuries, and 64 describing known yet possibly evolving injuries. HAPI incidence was 11.9 per 1000 discharges, and incidence rate was 1.2 per 1000 bed-days.
AHRQ-funded; HS026246.
Citation: Milliren CE, Ozonoff A, Fournier KA .
Enhancing pressure injury surveillance using natural language processing.
J Patient Saf 2024 Mar 1; 20(2):119-24. doi: 10.1097/pts.0000000000001193.
Keywords: Pressure Ulcers, Healthcare-Associated Infections (HAIs), Health Information Technology (HIT)
Sanghavi P, Chen Z
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
The purpose of this study was to evaluate the relationship between nursing home characteristics and reporting of 2 of 3 specific clinical outcomes reported by the Nursing Home Care Compare (NHCC) website: major injury falls and pressure ulcers. The researchers of this quality improvement study utilized hospitalization data for all Medicare fee-for-service beneficiaries between January 1, 2011, and December 31, 2017. Hospital admission claims for major injury falls and pressure ulcers were linked with facility-reported evaluations at the nursing home resident level. For each linked hospital claim, it was determined whether the nursing home had reported the event and rates of reporting were computed. To evaluate whether nursing homes reported similarly on both measures, the researchers estimated the relationship between reporting of major injury falls and pressure ulcers within a nursing home, and explored racial and ethnic disparities that could otherwise explain the associations. The study sample included 13,179 nursing homes where 131,000 residents experienced major injury fall or pressure ulcer hospitalizations. Of the 98,669 major injury fall hospitalizations, 60.0% were reported, and of the 39,894 stage 3 or 4 pressure ulcer hospitalizations, 67.7% were reported. Underreporting for both conditions was pervasive, with 69.9% and 71.7% of nursing homes having reporting rates less than 80% for major injury fall and pressure ulcer hospitalizations, respectively. Lower reporting rates had few correlations with facility characteristics other than racial and ethnic composition. Facilities with high vs low fall reporting rates had significantly more White residents (86.9% vs 73.3%), and facilities with high vs low pressure ulcer reporting rates had significantly fewer White residents (69.7% vs 74.9%).
AHRQ-funded; HS026957.
Citation: Sanghavi P, Chen Z .
Underreporting of quality measures and associated facility characteristics and racial disparities in US nursing home ratings.
JAMA Netw Open 2023 May; 6(5):e2314822. doi: 10.1001/jamanetworkopen.2023.14822..
Keywords: Quality Measures, Quality of Care, Elderly, Disparities, Racial and Ethnic Minorities, Nursing Homes, Pressure Ulcers, Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Long-Term Care
Padula WV, Gibbons RD, Pronovost PJ
Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model.
Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6 percent, are costly to treat, and result in Medicare reimbursement penalties. The study’s objective was to use electronic health records to predict pressure ulcers and to identify coding issues leading to penalties. Its analysis identified spinal cord injuries as high risk for HAPUs and as being often inappropriately coded without paralysis.
AHRQ-funded; HS023710.
Citation: Padula WV, Gibbons RD, Pronovost PJ .
Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model.
J Am Med Inform Assoc 2017 Apr 1;24(e1):e95-e102. doi: 10.1093/jamia/ocw118.
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Keywords: Pressure Ulcers, Healthcare-Associated Infections (HAIs), Electronic Health Records (EHRs), Health Information Technology (HIT)
Krishnan S, Karg PE, Boninger ML
Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediators.
The authors aimed to identify changes in concentrations of inflammatory mediators in plasma and urine after traumatic spinal cord injury and before the occurrence of a first pressure ulcer. They found that an increase in concentration of the chemokine interferon-γ-induced protein in plasma and a decrease in concentration of the cytokine interferon-α in urine were observed before occurrence of a first pressure ulcer compared with matched controls. They concluded that inflammatory mediators should be explored as possible biomarkers for identifying individuals at risk for pressure ulcer formation.
AHRQ-funded; HS022134.
Citation: Krishnan S, Karg PE, Boninger ML .
Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediators.
Arch Phys Med Rehabil 2016 Oct;97(10):1656-62. doi: 10.1016/j.apmr.2016.01.003.
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Keywords: Pressure Ulcers, Healthcare-Associated Infections (HAIs), Injuries and Wounds
Padula WV, Gibbons RD, Valuck RJ
Are evidence-based practices associated with effective prevention of hospital-acquired pressure ulcers in US academic medical centers?
The objective of this study was to evaluate the longitudinal impact of CMS policy and quality improvement adoption on hospital-acquired pressure ulcers (HAPU) rates. It concluded that HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of evidence-based practices for HAPU prevention.
AHRQ-funded; HS023710.
Citation: Padula WV, Gibbons RD, Valuck RJ .
Are evidence-based practices associated with effective prevention of hospital-acquired pressure ulcers in US academic medical centers?
Med Care 2016 May;54(5):512-8. doi: 10.1097/mlr.0000000000000516..
Keywords: Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Pressure Ulcers, Quality Improvement
Creehan S, Cuddigan J, Gonzales D
The VCU pressure ulcer summit-developing centers of pressure ulcer prevention excellence: a framework for sustainability.
The purpose of this paper is to present a framework describing the proposed Magnet-designated Centers of Pressure Ulcer Prevention Excellence resulting from a national summit convened at the Virginia Commonwealth University Medical Center in March 2014. The authors discussed the structures, processes, and outcome measures necessary to become a proposed Center of Pressure Ulcer Prevention Excellence.
AHRQ-funded; HS023710.
Citation: Creehan S, Cuddigan J, Gonzales D .
The VCU pressure ulcer summit-developing centers of pressure ulcer prevention excellence: a framework for sustainability.
J Wound Ostomy Continence Nurs 2016 Mar-Apr;43(2):121-8. doi: 10.1097/won.0000000000000203.
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Keywords: Guidelines, Healthcare-Associated Infections (HAIs), Outcomes, Patient Safety, Pressure Ulcers
Padula WV, Valuck RJ, Makic MB
Factors influencing adoption of hospital-acquired pressure ulcer prevention programs in US academic medical centers.
The purpose of this study was to identify wound care nurse perceptions of the primary factors that influenced, the overall reduction of pressure ulcers (PUs). It found that several internal factors influenced evidence-based practice: hospital prevention campaigns; the availability of nursing specialists; and the level of preventive knowledge among hospital staff. External influential factors included financial concerns and data sharing among peer institutions.
AHRQ-funded; HS023710.
Citation: Padula WV, Valuck RJ, Makic MB .
Factors influencing adoption of hospital-acquired pressure ulcer prevention programs in US academic medical centers.
J Wound Ostomy Continence Nurs 2015 Jul-Aug;42(4):327-30. doi: 10.1097/won.0000000000000145..
Keywords: Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Nursing, Patient Safety, Pressure Ulcers, Prevention
Stifter J, Yao Y, Lopez KD
Proposing a new conceptual model and an exemplar measure using health information: Technology to examine the impact of relational nurse continuity on hospital-acquired pressure ulcers.
The authors present a new conceptual model and an innovative use of health information technology to measure relational nurse continuity and to demonstrate the potential for bringing the results of big data science back to the bedside. Understanding the power of big data to address critical clinical issues may foster a new direction for nursing administration theory development.
AHRQ-funded; HS023072.
Citation: Stifter J, Yao Y, Lopez KD .
Proposing a new conceptual model and an exemplar measure using health information: Technology to examine the impact of relational nurse continuity on hospital-acquired pressure ulcers.
ANS Adv Nurs Sci 2015 Jul-Sep;38(3):241-51. doi: 10.1097/ans.0000000000000081.
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Keywords: Nursing, Pressure Ulcers, Quality of Care, Health Information Technology (HIT), Healthcare-Associated Infections (HAIs)
Meddings J, Reichert H, Rogers MA
Under pressure: Financial effect of the hospital-acquired conditions initiative-a statewide analysis of pressure ulcer development and payment.
This study assessed the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. It found that the total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV.
AHRQ-funded; HS019767; HS018334.
Citation: Meddings J, Reichert H, Rogers MA .
Under pressure: Financial effect of the hospital-acquired conditions initiative-a statewide analysis of pressure ulcer development and payment.
J Am Geriatr Soc 2015 Jul;63(7):1407-12. doi: 10.1111/jgs.13475..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare-Associated Infections (HAIs), Pressure Ulcers, Patient Safety, Healthcare-Associated Infections (HAIs)
Padula WV, Makic MB, Mishra MK
Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.
This study was conducted to determine the comparative effectiveness of quality improvement interventions associated with reduced hospital-acquired pressure ulcer rates. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition.
AHRQ-funded; HS023710.
Citation: Padula WV, Makic MB, Mishra MK .
Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.
Jt Comm J Qual Patient Saf 2015 Jun;41(6):246-5..
Keywords: Comparative Effectiveness, Healthcare-Associated Infections (HAIs), Patient Safety, Pressure Ulcers, Prevention, Quality Improvement
Padula WV, Makic MB, Wald HL
Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy.
This study was conducted to define changes in hospital-acquired pressure ulcers (HAPU) incidence and variance since 2008. It found that HAPU incidence rates decreased significantly among 210 University HealthSystems Consortium academic medical centers after the enactment of the CMS nonpayment policy. This suggests that governmental policy was a significant driver of change in clinical practice for wound care and created incentives for preventive efforts on the part of hospitals.
AHRQ-funded; HS023710.
Citation: Padula WV, Makic MB, Wald HL .
Hospital-acquired pressure ulcers at academic medical centers in the United States, 2008-2012: tracking changes since the CMS nonpayment policy.
Jt Comm J Qual Patient Saf 2015 Jun;41(6):257-63..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Policy, Pressure Ulcers, Prevention, Quality Improvement