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Some pressure ulcer data don't reflect hospital quality

Sunday October 20, 2013
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The data Medicare uses to publicly report hospital pressure ulcer rates is not an accurate source for comparing hospitals based on how well they prevent the condition, according to a study.

Pressure ulcers are among the hospital-acquired conditions reported by Medicare’s Hospital Compare website. Starting in fiscal year 2015, pressure ulcers will be part of a Medicare reimbursement formula that penalizes hospitals with a high rate of hospital-acquired conditions.

Hospital pressure ulcer rates vary widely based on how the data was collected, unfairly making some hospitals appear to fare better or worse than others, according to study findings published in the Oct. 15 issue of the Annals of Internal Medicine.

“We found drastic differences in performance for bedsore rates depending on which type of data was reviewed — hospitals could be graded as either superior or below average depending on the type of data used,” lead author Jennifer Meddings, MD, MSc, an assistant professor in internal medicine at the University of Michigan Medical School in Ann Arbor, said in a news release. “This raises significant concerns about how accurately hospitals are being compared to each other, as this information is reported to the public and may lead to financial penalties for hospitals that seem to be doing poorly.”

In the study, researchers retroactively examined 2 million all-payer administrative records from 448 California hospitals and quarterly hospitalwide surveillance data from 213 hospitals from the Collaborative Alliance for Nursing Outcomes. They kept the data from 196 hospitals that had at least six months of administrative and surveillance records available. The records were for nonobstetric patients who were discharged in 2009.

Researchers used administrative data and bedside surveillance data for patients who had at least one stage 2 or greater hospital-acquired pressure ulcer to calculate a pair of hospital-specific rates. When they used the administrative data, the average hospital-specific rate was 0.15%. However, when bedside exam data were used, the average hospital-specific rate was 2%.

In bedside exams, trained teams of independent nurses record rates by periodically evaluating patients for pressure ulcers through a comprehensive skin exam. In contrast, administrative data comes from hospital coders reviewing medical record notes from physicians and wound care teams.

Among the 49 hospitals with hospital-acquired pressure ulcer rates in the worst quartile when the calculations were based on administrative data, use of the bedside exam data set yielded performance grades of “superior” for three of these hospitals, “above average” for 14, “average” for 15 and “below average” for 17.

“Hospital performance scores generated from [hospital-acquired stage 2 or greater pressure ulcer] rates varied considerably according to whether administrative or surveillance data were used, suggesting that administrative data may not be appropriate for comparing hospitals,” the authors concluded.

The study was funded through the Agency for Healthcare Research and Quality.

Study abstract: http://annals.org/article.aspx?articleid=1748841


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