NORC at the University of Chicago, Bethesda, MD.
NORC at the University of Chicago, Bethesda, MD.
J Am Med Dir Assoc. 2019 Jul;20(7):816-821.e2. doi: 10.1016/j.jamda.2019.02.008. Epub 2019 Apr 4.
Pressure ulcers pose an important quality-of-care challenge in nursing homes, with serious consequences for residents' health. We assessed the scalability of the On-Time Pressure Ulcer Prevention (On-Time) intervention strategy, developed by the Agency for Healthcare Research & Quality, in nursing homes nationwide.
On-Time uses electronic health record reports to identify changes in resident pressure ulcer risk and facilitate multidisciplinary input into clinical decision making.
To assess the scalability and impact of On-Time on pressure ulcer incidence in nursing homes.
We used quasi-experimental methods, employing a difference-in-differences design, to compare the pre-post trends in pressure ulcer incidence in the treatment and comparison homes.
The study population included long-stay residents at high risk for developing pressure ulcers in 47 nursing homes and matched comparison homes in 17 states.
Stage 2 to 4 pressure ulcer incidence among long-stay residents who met the criteria for high risk, identified using an algorithm adapted from the Minimum Data Set 3.0 Percent of High-Risk Residents with Pressure Ulcers (Long Stay) measure.
The overall decline in pressure ulcer rates for treatment relative to matched comparison homes was statistically insignificant (P > .05). A subgroup of heterogeneous homes experienced a statistically significant decline of 3.24 percentage points (61.0% relative decrease) in pressure ulcer rates relative to matched comparison homes, but no uniting characteristic common across homes readily explained their success.
CONCLUSIONS/IMPLICATIONS: Scalability of future health information technology-based quality improvement interventions in nursing home settings requires nuanced implementation support, particularly around electronic health record report accessibility and accuracy.
压疮是养老院护理质量的一个重要挑战，会对居民的健康造成严重后果。我们评估了美国医疗保健研究与质量局开发的按时压疮预防（On-Time）干预策略在全国养老院的可扩展性。
On-Time 使用电子健康记录报告来识别居民压疮风险的变化，并促进多学科参与临床决策。
评估 On-Time 在养老院压疮发生率方面的可扩展性和影响。
我们使用准实验方法，采用差异差异设计，比较治疗和对照住宅中压疮发生率的预前后趋势。
研究人群包括在 17 个州的 47 家养老院和匹配对照住宅中患有压疮高风险的长期居民。
符合高风险标准的长期居民（使用来自最小数据集 3.0 的算法确定）的 2 期至 4 期压疮发生率。
治疗组相对于匹配对照组的压疮率总体下降无统计学意义（P>.05）。一组异质住宅的压疮率下降了 3.24 个百分点（相对减少 61.0%），与匹配对照组相比具有统计学意义，但没有一个统一的特征可以解释这些住宅的成功。
结论/意义：未来基于健康信息技术的质量改进干预措施在养老院环境中的可扩展性需要细致的实施支持，特别是在电子健康记录报告的可访问性和准确性方面。
