Rudman D, Slater E J, Richardson T J, Mattson D E
Geriatric Medicine Sections, Veterans Affairs Medical Center, Milwaukee, WI 53295-1000.
J Gen Intern Med. 1993 Dec;8(12):653-8. doi: 10.1007/BF02598281.
In the 27 nursing homes located within the Veterans Affairs (VA) Central Region, the proportion of residents with pressure ulcers in 1986 varied from 2% to 16%. Three of these nursing homes were selected for study: nursing home A from the highest prevalence quintile, B from close to the median, and C from the lowest quintile.
Two indicators of pressure ulcer occurrence were calculated: the point-in-time prevalence of bedsores and the percentage of residents who were free of pressure ulcers at the beginning of a six-month study period but who had bedsores six months later. Data were also collected in each nursing home to determine the bedsore status at the time of admission and the resident's location if and when a bedsore began.
The three institutions were generally similar in available measures of casemix and severity of illness. The ratio of nursing and medical personnel to residents was 29%-76% lower in nursing home A than in B or C. In nursing home A, the turnover of nursing personnel was about twice as rapid as that in B or C. In each institution the pressure ulcer statistics showed little variation from one six-month period to another. The average rates in nursing home A were 15.3% for prevalence and 10.3% for the six-month conversion from bedsore-negative to bedsore-positive status. The average rates in facilities B and C were, respectively, 6.9% and 3.5% for prevalence and 4.7% and 4.2% for the six-month conversion from negative to positive status. Furthermore, the number of new bedsores that developed during uninterrupted nursing home residence, per 100,000 resident days, was 36.5 in A, 10.8 in B, and 2.1 in C.
The pressure ulcer statistics in nursing homes B and C were consistently superior to those in A. the interinstitutional differences could not be explained by the comparisons of scoring methodologies and of casemixes that were made. It is hypothesized that more favorable staffing patterns in B and C than in A contributed to more effective prevention of bedsores in the former two institutions.
在退伍军人事务部（VA）中部地区的27家疗养院中，1986年压疮患者的比例在2%至16%之间。从这些疗养院中选取了三家进行研究：A疗养院来自患病率最高的五分之一组，B疗养院接近中位数，C疗养院来自患病率最低的五分之一组。
计算了两个压疮发生指标：褥疮的即时患病率以及在为期六个月的研究期开始时没有压疮但六个月后出现褥疮的居民百分比。还在每家疗养院收集了数据，以确定入院时的褥疮状况以及褥疮发生时居民的位置。
这三家机构在病例组合和疾病严重程度的现有测量指标上总体相似。A疗养院的护理和医疗人员与居民的比例比B或C疗养院低29% - 76%。在A疗养院，护理人员的更替速度约为B或C疗养院的两倍。在每个机构中压疮统计数据在不同的六个月期间变化不大。A疗养院的患病率平均为15.3%，从褥疮阴性转为阳性状态的六个月转化率为10.3%。B和C疗养院的患病率平均分别为6.9%和3.5%，从阴性转为阳性状态的六个月转化率分别为4.7%和4.2%。此外，每100000居民日在疗养院连续居住期间新出现的褥疮数量，A疗养院为36.5例；B疗养院为10.8例；C疗养院为2.1例。
B和C疗养院的压疮统计数据始终优于A疗养院。机构间的差异无法通过所做的评分方法和病例组合比较来解释。据推测，B和C疗养院比A疗养院更有利的人员配备模式有助于前两家机构更有效地预防褥疮。
