Bliss Donna Z, Gurvich Olga, Savik Kay, Eberly Lynn E, Harms Susan, Mueller Christine, Garrard Judith, Cunanan Kristen, Wiltzen Kjerstie
University of Minnesota, School of Nursing, Minneapolis, MN, United States.
University of Minnesota, School of Nursing, Minneapolis, MN, United States.
Arch Gerontol Geriatr. 2017 Sep;72:187-194. doi: 10.1016/j.archger.2017.06.009. Epub 2017 Jun 27.
Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers.
To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets.
Minimum Data Set records of older individuals admitted to one of 439 nursing homes of a national, for-profit chain over three years with a stages 2-4 pressure ulcer (n=10,861) were searched to the 90-day assessment for the first record showing pressure ulcer healing. Predictors of pressure ulcer healing were analyzed for White admissions first using logistic regression. The Peters-Belson method was used to assess racial or ethnic disparities among minority group admissions.
A significantly smaller proportion of Black nursing home admissions had their pressure ulcer heal than expected had they been part of the White group. There were no disparities in pressure ulcer healing disadvantaging other minority groups. Significant predictors of a nonhealing of pressure ulcer were greater deficits in activities of daily living and pressure ulcer severity.
Reducing disparities in pressure ulcer healing is needed for Blacks admitted to nursing homes. Knowledge of disparities in pressure ulcer healing can direct interventions aiming to achieve equity in healthcare for a growing number of minority nursing home admissions.
压疮会增加疗养院居民住院费用高昂及死亡的风险，因此及时愈合很重要。已发现疗养院人群在医疗保健方面存在差异，但对于压疮愈合方面的差异知之甚少。
评估疗养院入院时存在的压疮愈合方面的种族和民族差异。在三个大型数据集中，对个体居民、疗养院以及社区/普查区层面的多层次预测因素进行了研究。
检索了一家全国性营利性连锁机构的439家疗养院中，在三年期间入院且患有2 - 4期压疮的老年人（n = 10,861）的最低数据集记录，直至首次出现压疮愈合的90天评估记录。首先使用逻辑回归分析白人入院患者压疮愈合的预测因素。采用彼得斯 - 贝尔森方法评估少数群体入院患者之间的种族或民族差异。
与假设他们属于白人组时相比，黑人疗养院入院患者中压疮愈合的比例明显低于预期。在压疮愈合方面，其他少数群体没有受到不利影响的差异。压疮未愈合的显著预测因素是日常生活活动能力的更大缺陷和压疮严重程度。
需要减少疗养院黑人入院患者在压疮愈合方面的差异。了解压疮愈合方面的差异可以指导旨在为越来越多的少数群体疗养院入院患者实现医疗保健公平的干预措施。
