*Abt Associates Inc., US Health Division, Cambridge, MA †Agency for Healthcare Research & Quality, US Department of Health & Human Services ‡Social & Scientific Systems Inc., Rockville, MD.
Med Care. 2014 Mar;52(3):258-66. doi: 10.1097/MLR.0000000000000080.
Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates.
To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents.
We employed an interrupted time-series design to identify impacts of 4 core On-Time program components on resident pressure ulcer incidence in 12 New York State nursing homes implementing the intervention (n=3463 residents). The sample was purposively selected to include nursing homes with high baseline prevalence and incidence of pressure ulcers and high motivation to reduce pressure ulcers. Differential timing and sequencing of 4 core On-Time components across intervention nursing homes and units enabled estimation of separate impacts for each component. Inclusion of a nonequivalent comparison group of 13 nursing homes not implementing On-Time (n=2698 residents) accounts for potential mean-reversion bias. Impacts were estimated via a random-effects Poisson model including resident-level and facility-level covariates.
We find a large and statistically significant reduction in pressure ulcer incidence associated with the joint implementation of 4 core On-Time components (incidence rate ratio=0.409; P=0.035). Impacts vary with implementation of specific component combinations.
On-Time implementation is associated with sizable reductions in pressure ulcer incidence.
压疮会对养老院居民的健康和经济造成严重后果。美国医疗保健研究与质量局与纽约州卫生部合作，实施了长期护理及时质量改进（On-Time）的压疮模块，这是一种临床决策支持干预措施，旨在降低压疮发生率。
评估 On-Time 计划在降低养老院居民院内获得性压疮发生率方面的有效性。
我们采用了中断时间序列设计，以确定 On-Time 计划的 4 个核心组成部分对 12 家纽约州养老院居民压疮发生率的影响（n=3463 名居民）。该样本是有目的地选择的，包括基线压疮发生率和患病率较高、有降低压疮意愿的养老院。干预养老院和单位中 4 个核心 On-Time 组成部分的不同时间和顺序安排，使我们能够分别估计每个组成部分的影响。包括 13 家未实施 On-Time 的非对照养老院（n=2698 名居民），以考虑潜在的均值回归偏差。通过包括居民层面和设施层面协变量的随机效应泊松模型来估计影响。
我们发现，联合实施 4 个核心 On-Time 组成部分与压疮发生率的大幅显著降低相关（发病率比=0.409；P=0.035）。影响因具体组件组合的实施而有所不同。
On-Time 的实施与压疮发生率的大幅降低相关。
