Berlowitz D R, Brand H K, Perkins C
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, MA 01730, USA.
J Am Geriatr Soc. 1999 Jun;47(6):692-6. doi: 10.1111/j.1532-5415.1999.tb01591.x.
To determine how often hospital administrative databases capture the occurrence of two common geriatric syndromes, pressure ulcers and incontinence.
Retrospective comparison of a nursing home and hospital database.
Department of Veterans Affairs (VA) hospitals.
All patients between 1992 and 1996 discharged from VA acute medical care and admitted to a VA nursing home.
The presence of incontinence or a pressure ulcer (stage 2 or larger) on admission to the nursing home was determined. Hospital discharge diagnoses were then reviewed to determine whether these conditions were recorded. The effect of ulcer stage, total number of discharge diagnoses, and temporal trends on the recording of these conditions in discharge diagnoses was also noted.
There were 17,004 admissions to nursing homes from acute care in 1996; 12.7% had a pressure ulcer and 43.4% were incontinent. Among these patients with a pressure ulcer, the hospital discharge diagnosis listed an ulcer in 30.8% of cases, and incontinence was included correctly as a discharge diagnosis in 3.4%. While deeper pressure ulcers were more likely to be recorded than superficial ulcers (P < .01), nearly 50% of stage 4 ulcers were not listed among hospital discharge diagnoses. Patients with more discharge diagnoses were more likely to record both conditions correctly. From 1992 to 1996, small but significant (P = .001) improvements were noted in the correct recording of these geriatric syndromes as discharge diagnoses.
The occurrence of pressure ulcers and incontinence cannot be determined from hospital administrative databases and should not be used as outcomes when measuring quality of care among hospitalized patients.
确定医院管理数据库多久能捕捉到两种常见的老年综合征——压疮和失禁的发生情况。
养老院数据库与医院数据库的回顾性比较。
退伍军人事务部（VA）医院。
1992年至1996年间从VA急性医疗护理机构出院并入住VA养老院的所有患者。
确定患者入住养老院时是否存在失禁或压疮（2期或更严重）。然后审查医院出院诊断，以确定这些情况是否被记录。还记录了溃疡分期、出院诊断总数以及时间趋势对这些情况在出院诊断中记录的影响。
1996年有17004名患者从急性护理机构入住养老院；12.7%的患者有压疮，43.4%的患者失禁。在这些有压疮的患者中，医院出院诊断中列出溃疡的病例占30.8%，失禁作为出院诊断被正确列入的占3.4%。虽然深度压疮比浅表压疮更有可能被记录（P < 0.01），但近50%的4期压疮未在医院出院诊断中列出。出院诊断较多的患者更有可能正确记录这两种情况。从1992年到1996年，作为出院诊断正确记录这些老年综合征的情况有小幅但显著的改善（P = 0.001）。
无法从医院管理数据库中确定压疮和失禁的发生情况，在衡量住院患者的护理质量时，不应将其用作结果指标。
