Bates-Jensen Barbara M, Cadogan Mary, Osterweil Dan, Levy-Storms Lené, Jorge Jennifer, Al-Samarrai Nahla, Grbic Valena, Schnelle John F
Division of Geriatrics, School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
J Am Geriatr Soc. 2003 Sep;51(9):1203-12. doi: 10.1046/j.1532-5415.2003.51403.x.
To determine whether nursing homes (NHs) that score in the extreme quartiles of pressure ulcer (PU) prevalence as reported on the Minimum Data Set (MDS) PU quality indicator provide different PU care.
Descriptive, cohort.
Sixteen NHs.
Three hundred twenty-nine NH residents at risk for PU development as determined by the PU Resident Assessment Protocol of the MDS.
: Sixteen care process quality indicators (10 specific to PU care processes, five related to nutrition, and one related to incontinence management) were scored using medical record data, direct human observation, interviews, and data from wireless thigh movement monitors.
There were no differences between homes with low- and high-PU prevalence rates reported on the MDS PU quality indicator on most care processes. NHs with high PU prevalence rates used pressure-reduction surfaces more frequently and were better at documentation of four wound characteristics when PUs were present. No measure of PU care processes was better in low-PU NHs. Neither low- nor high-PU prevalence NHs routinely repositioned residents every 2 hours, even though 2-hour repositioning was documented in the medical record for nearly all residents.
The assumption that homes with fewer PUs and thus low PU prevalence according to the MDS PU quality indicator are providing better PU care was not supported in this sample. NHs that scored low on the MDS PU quality indicator did not provide significantly better care than NHs that scored high. All NHs could improve PU prevention, as evidenced by the poor performance on prevention care processes by low- and high-PU NHs. The MDS PU quality indicator is not a useful measure of the quality of PU care in NHs and can be misleading if not presented with an explanation of the meaning of the indicator.
根据最低数据集（MDS）压力性溃疡（PU）质量指标报告，确定在PU患病率处于极端四分位数的养老院是否提供不同的PU护理。
描述性队列研究。
16家养老院。
根据MDS的PU居民评估协议确定的329名有发生PU风险的养老院居民。
使用病历数据、直接人工观察、访谈以及无线大腿运动监测器的数据，对16项护理过程质量指标（10项特定于PU护理过程、5项与营养相关、1项与失禁管理相关）进行评分。
在大多数护理过程中，MDS PU质量指标报告的PU患病率低和高的养老院之间没有差异。PU患病率高的养老院更频繁地使用减压表面，并且在出现PU时对四种伤口特征的记录更好。在PU患病率低的养老院中，没有一项PU护理过程指标更好。PU患病率低和高的养老院都没有按照常规每2小时为居民重新定位一次，尽管几乎所有居民的病历中都记录了2小时重新定位。
根据MDS PU质量指标，PU较少且患病率低的养老院提供更好的PU护理这一假设在本样本中未得到支持。在MDS PU质量指标上得分低的养老院提供的护理并不比得分高的养老院显著更好。所有养老院都可以改善PU预防，PU患病率低和高的养老院在预防护理过程中的不佳表现证明了这一点。MDS PU质量指标不是衡量养老院PU护理质量的有用指标，如果不解释该指标的含义，可能会产生误导。
