Padula William V, Makic Mary Beth F, Mishra Manish K, Campbell Jonathan D, Nair Kavita V, Wald Heidi L, Valuck Robert J
Section of Hospital Medicine, University of Chicago, USA.
Jt Comm J Qual Patient Saf. 2015 Jun;41(6):246-56. doi: 10.1016/s1553-7250(15)41034-7.
Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates.
In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention.
Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (p<.05).
Five QI interventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.
压疮预防是医疗保险和医疗补助服务中心（CMS）2008年不支付政策所针对的医院获得性疾病（HACs）之一，是一个关键问题。本研究旨在确定与降低医院获得性压疮（HAPU）发生率相关的质量改进（QI）干预措施的比较效果。
采用准实验设计，进行中断时间序列分析，以确定HAPU发生率与采用QI干预措施之间的相关性。在大学卫生系统联盟的医院中，于2007年9月至2012年2月对55家学术医疗中心进行了调查，以了解预防压疮的QI干预措施的采用模式，并分析了5208例压疮病例的医院层面数据。在CMS政策干预后，采用t检验对医院间和医院内的降低显著性进行了测试。
55家医院中有53家（96%）采用了QI干预措施来预防压疮。效应量分析确定了五种有效的干预措施，每种措施每季度每1000例患者出院时压疮发生率降低超过1例：领导倡议、视觉工具、压疮分期、皮肤护理和患者营养。在采用过程的早期，发生率下降幅度最大（p<0.05）。
在55家学术医疗中心，五种QI干预措施与降低III期和IV期HAPU发生率具有临床意义上的关联。这些QI干预措施可用于支持基于证据的压疮预防方案。医院不仅可以将本研究的这些发现用作预防HAPU的QI组合的一部分。
