Are We Improving the Quality of Nursing Home Care: The Case of Pressure Ulcers

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Abstract
BACKGROUND: There are widespread concerns regarding the quality of nursing home care and whether care is improving. We evaluated a large provider of nursing home care to determine whether risk‐adjusted rates of pressure ulcer development have changed. METHODS: We used the Minimum Data Set to study National HealthCare Corporation nursing homes from 1991 through 1995. Rates of pressure ulcer development were calculated for successive 6‐month periods by determining the proportion of residents initially ulcer‐free having a stage 2 or larger pressure ulcer on subsequent assessments. Rates were risk‐adjusted for patient characteristics. The proportion of new ulcers that were deep (stages 3 or 4) were also calculated. RESULTS: We examined risk‐adjusted rates of pressure ulcer development based on 144,379 observations of 30,510 residents at 107 nursing homes. The number of observations per 6‐month period ranged from 11,041 to 15,805. Between 1991 and 1995, there was a significant (P < .05) rate decline of more than 25%. Additionally, the proportion of new ulcers that were stages 3 or 4 declined from 30 to 22% (P < .01). CONCLUSIONS: Nursing homes showed significant improvement in the quality of pressure ulcer preventive care from 1991 to 1995. J Am Geriatr Soc 48: 59–62, 2000.

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