Rudman D, Mattson D E, Alverno L, Richardson T J, Rudman I W
Department of Medicine, Medical College of Wisconsin, Milwaukee.
J Am Geriatr Soc. 1993 Dec;41(12):1317-25. doi: 10.1111/j.1532-5415.1993.tb06482.x.
Pressure ulcer prevalences in 30 VA nursing homes in 1986 ranged from 0% to 15%. The institutions with lowest ("A") and highest ("B") prevalence were selected for further examination.
Analysis of nursing home files for five study periods, each lasting 6 months.
A and B were 60-bed rural and 280-bed urban facilities, respectively.
Eleven outcome indicators were calculated for each study period: prevalences and incidences of pressure ulcer, aggressive behavior and disruptive behavior, 6-month declines in each of the four activities of daily living (ADLs), and prevalence of underweight.
Populations in A and B were similar with regard to age, sex, length of stay, degree of dependency, and level of nursing care. All indicators for the first study period were more favorable in A than in B. In addition, underweight (body mass index < 22 kg/M2) was significantly less prevalent in A than in B. The differences between the two institutions in the indicators were persistent over the five study periods from 1988 to 1991.
The populations of A and B were similar in the available measures of severity of illness. Nevertheless, the residents in nursing home A were significantly less likely to experience adverse outcomes than were the residents in nursing home B. The virtual absence of pressure ulcers, physical aggression, and verbal disruption in nursing home A, despite the presence of many immobile and demented residents, suggested that these complications can mostly be prevented.
1986年30家退伍军人管理局疗养院的压疮患病率在0%至15%之间。选取患病率最低（“A”）和最高（“B”）的机构进行进一步检查。
对五个研究阶段的疗养院档案进行分析，每个阶段持续6个月。
A是一家有60张床位的农村疗养院，B是一家有280张床位的城市疗养院。
为每个研究阶段计算11项结果指标：压疮的患病率和发病率、攻击行为和破坏行为、四项日常生活活动（ADL）中每项活动的6个月下降情况以及体重过轻的患病率。
A和B的人群在年龄、性别、住院时间、依赖程度和护理水平方面相似。第一个研究阶段的所有指标在A机构都比在B机构更有利。此外，A机构体重过轻（体重指数<22 kg/M2）的患病率明显低于B机构。从1988年到1991年的五个研究阶段中，两个机构在这些指标上的差异一直存在。
A和B的人群在现有的疾病严重程度衡量指标方面相似。然而，A疗养院的居民出现不良后果的可能性明显低于B疗养院的居民。尽管A疗养院有许多行动不便和患有痴呆症的居民，但压疮、身体攻击和言语干扰几乎不存在，这表明这些并发症大多是可以预防的。
