Rondinelli June, Zuniga Stephen, Kipnis Patricia, Kawar Lina Najib, Liu Vincent, Escobar Gabriel J
June Rondinelli, PhD, RN, CNS, is Nurse Scientist and Interim Director, Regional Nursing Research Program, Kaiser Permanente, Southern California, Pasadena. Stephen Zuniga, PhD, is Biostatistician II, Clinical Intelligence and Decision Support, Kaiser Foundation Hospitals, Pasadena, California. Patricia Kipnis, PhD, is Principal Statistician/Associate Director, Decision Support, Kaiser Foundation Hospitals, Oakland, California. Lina Najib Kawar, PhD, RN, CNS, is Nurse Scientist, Regional Nursing Research Program, Kaiser Permanente, Southern California, Pasadena. Vincent Liu, MD, MS, is Research Scientist, Division of Research, Kaiser Permanente, Oakland, California. Gabriel J. Escobar, MD, is Research Scientist III, Regional Director for Hospital Operations Research, Division of Research, Kaiser Permanente, Oakland, California.
Nurs Res. 2018 Jan/Feb;67(1):16-25. doi: 10.1097/NNR.0000000000000258.
Although healthcare organizations have decreased hospital-acquired pressure injury (HAPI) rates, HAPIs are not eliminated, driving further examination in both nursing and health services research.
The objective was to describe HAPI incidence, risk factors, and risk-adjusted hospital variation within a California integrated healthcare system.
Inpatient episodes were included in this retrospective cohort if patients were hospitalized between January 1, 2013, and June 30, 2015. The primary outcome was development of a HAPI over time. Predictors included cited HAPI risk factors in addition to incorporation of a longitudinal comorbidity burden (Comorbidity Point Score, Version 2 [COPS2]), a severity-of-illness score (Laboratory-Based Acute Physiology Score, Version 2 [LAPS2]), and the Braden Scale for Predicting Pressure Ulcer Risk.
Analyses included HAPI inpatient episodes (n = 1661) and non-HAPI episodes (n = 726,605). HAPI incidence was 0.57 per 1,000 patient days (95% CI [0.019, 3.805]) and 0.2% of episodes. A multivariate Cox proportional hazards model showed significant (p < .001) hazard ratios (HRs) for the change from the 25th to the 75th percentile for age (HR = 1.36, 95% CI [1.25, 1.45]), higher COPS2 scores (HR = 1.10, 95% CI [1.04, 1.16]), and higher LAPS2 scores (HR = 1.38, 95% CI [1.28, 1.50]). Female gender, an emergency room admission for a medical reason, and higher Braden scores showed significant protective HRs (HR < 1.00, p < .001). After risk adjustment, significant variation remained among the 35 hospitals.
Results prompt the consideration of age, severity of illness (LAPS2), comorbidity indexes (COPS2), and the Braden score as important predictors for HAPI risk. HAPI rates may be low; however, because of significant individual site variation, HAPIs remain an area to explore through both research and quality improvement initiatives.
尽管医疗机构已降低了医院获得性压力性损伤（HAPI）的发生率，但HAPI并未消除，这促使护理和卫生服务研究领域进行进一步的调查。
目的是描述加利福尼亚州一个综合医疗系统内的HAPI发生率、风险因素以及风险调整后的医院差异。
如果患者在2013年1月1日至2015年6月30日期间住院，则将住院病例纳入该回顾性队列研究。主要结局是随时间推移发生HAPI。预测因素包括引用的HAPI风险因素，以及纳入纵向合并症负担（合并症评分系统第2版[COPS2]）、疾病严重程度评分（基于实验室的急性生理学评分第2版[LAPS2]）和预测压疮风险的Braden量表。
分析包括HAPI住院病例（n = 1661）和非HAPI病例（n = 726,605）。HAPI发生率为每1000患者日0.57例（95%可信区间[0.019, 3.805]），占病例数的0.2%。多变量Cox比例风险模型显示年龄从第25百分位数到第75百分位数变化的风险比（HR）显著（p <.001）（HR = 1.36, 95%可信区间[1.25, 1.45]）、COPS2评分较高（HR = 1.10, 95%可信区间[1.04, 1.16]）以及LAPS2评分较高（HR = 1.38, 95%可信区间[1.28, 1.50]）。女性、因医疗原因急诊入院以及较高的Braden评分显示出显著的保护HR（HR < 1.00, p <.001）。在进行风险调整后，35家医院之间仍存在显著差异。
结果促使人们考虑年龄、疾病严重程度（LAPS2）、合并症指数（COPS2）和Braden评分作为HAPI风险的重要预测因素。HAPI发生率可能较低；然而，由于各医院之间存在显著差异，HAPI仍然是一个需要通过研究和质量改进举措进行探索的领域。
