Department of Public Health Sciences, Biological Sciences Division, University of Chicago.
Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago Medical Center, Chicago, IL.
Med Care. 2022 Oct 1;60(10):775-783. doi: 10.1097/MLR.0000000000001763. Epub 2022 Aug 4.
The US government relies on nursing home-reported data to create quality of care measures and star ratings for Nursing Home Compare (NHC). These data are not systematically validated, and some evidence indicates NHC's patient safety measures may not be reliable.
The objective of this study was to assess the accuracy of NHC's pressure ulcer measures, which are chief indicators of nursing home patient safety.
For Medicare fee-for-service beneficiaries who were nursing home residents between 2011 and 2017, we identified hospital admissions for pressure ulcers and linked these to the nursing home-reported data at the patient level. We then calculated the percentages of pressure ulcers that were appropriately reported by stage, long-stay versus short-stay status, and race. After developing an alternative claims-based measure of pressure ulcer events, we estimated the correlation between this indicator and NHC-reported ratings.
Medicare nursing home residents with hospitalizations for pressure ulcers.
Pressure ulcer reporting rates; nursing home-level claims-based measure of pressure ulcer events.
Reporting rates were low for both short-stay (70.2% of 173,043 stage 2-4 pressure ulcer hospitalizations) and long-stay (59.7% of 137,315 stage 2-4 pressure ulcer hospitalizations) residents. Black residents experienced more severe pressure ulcers than White residents, however, this translated into having slightly higher reporting rates because higher staged pressure ulcers were more likely to be reported. Correlations between our claims-based measure and NHC ratings were poor.
Pressure ulcers were substantially underreported in data used by NHC to measure patient safety. Alternative approaches are needed to improve surveillance of health care quality in nursing homes.
美国政府依赖养老院报告的数据来制定护理院比较（NHC）的护理质量措施和星级评定。这些数据没有系统验证，一些证据表明 NHC 的患者安全措施可能不可靠。
本研究旨在评估 NHC 的压疮措施的准确性，这些措施是养老院患者安全的主要指标。
对于在 2011 年至 2017 年间居住在养老院的医疗保险付费服务受益人，我们确定了因压疮住院的患者，并将这些患者与患者层面的养老院报告数据进行了关联。然后，我们计算了按阶段、长期和短期入住状态以及种族适当报告的压疮百分比。在开发了一种替代的基于索赔的压疮事件衡量标准后，我们估计了该指标与 NHC 报告评级之间的相关性。
因压疮住院的医疗保险养老院居民。
压疮报告率；养老院层面基于索赔的压疮事件衡量标准。
无论是短期入住者（173043 例 2-4 期压疮住院患者中有 70.2%）还是长期入住者（137315 例 2-4 期压疮住院患者中有 59.7%），报告率都很低。黑人居民的压疮比白人居民更严重，但这转化为更高的报告率，因为更高阶段的压疮更有可能被报告。我们的基于索赔的衡量标准与 NHC 评级之间的相关性较差。
在 NHC 用于衡量患者安全的数据中，压疮的报告严重不足。需要采取替代方法来改善养老院医疗质量的监测。
