Study to help predict costly pressure ulcers
OASIS data will help with early intervention
The cost of treating pressure ulcers is estimated at $9 billion per year and the cost for care for home health patients with pressure ulcers is 36% more than the cost of caring for home health patients without pressure ulcers.1 One of the reasons for the increased cost is increased need for nursing visits: Patients with pressure ulcers require between one and two more nursing visits per week.2
"Add the cost of treating pressure ulcers in the home to the cost of re-hospitalization that many pressure ulcer patients receive, and this is definitely an issue to which home health agencies should pay attention," says Sandra Bergquist-Beringer, RN, PhD, CWCN, assistant professor, School of Nursing, University of Kansas who is a researcher on this topic. With re-hospitalization, a key component of Home Health Compare and a key factor in outcomes for pay for performance, it is important to address pressure ulcers before they develop or before they become too difficult to treat in the home, she says.
A collaborative study between Bergquist-Beringer and Cerner BeyondNow, a Kansas City, MO-based home care information technology company, is designed to help home health agencies predict which patients are most likely to develop pressure ulcers. "If we can more accurately identify patients at risk for pressure ulcers, we can initiate prevention strategies at the beginning of care," says Bergquist-Beringer.
A data extraction tool that relies on OASIS items commonly associated with pressure ulcer development has been developed and home health agencies are being recruited to participate in the study. "We begin data collection in the next year," says Kim Wipf, RN, BSN, CCRN, solution manager at Cerner BeyondNow. Two agencies participated in the pilot study and there are four agencies signed up for the more comprehensive study, she says. The only requirement for participation is the utilization of BeyondNow software, she adds. The goal is to collect information on 10,000 separate patients with unduplicated admissions.
Data collected in this part of the study will be used to develop more accurate prediction of pressure ulcer risks and identify effective interventions, says Bergquist-Beringer. "Pressure ulcers are not only extremely painful but they lead to other conditions such as depression, osteomyelitis, cellulitus, and frequently, re-hospitalization," she adds.
Previous research has shown that urine or stool incontinence, altered levels of activity, recent discharge from an institutional setting, and functional impairment are associated with pressure ulcer development, says Bergquist-Beringer. "Although the Braden Scale is often used to predict pressure ulcers in an institutional setting, very few studies have evaluated its effectiveness in home health," she adds. Her current study will see if use of OASIS data, along with tools such as the Braden Scale, is more effective. "We hope to identify other factors that contribute to increased pressure ulcer risk as well," she adds.
"The unique aspect of this study is that it focuses only on home health," points out Wipf. Home health nurses will use their point-of-care technology to input OASIS information and the system will alert them to the patient's increased risk for pressure ulcers, she explains. "The system will also suggest appropriate interventions," she adds.
Traditional interventions for pressure ulcers include:
- risk assessment upon admission;
- pressure redistribution, including the use of support systems and regular turning of patient;
- improvement of activity and mobility;
- nutritional support;
- reduce friction;
- improved education for patient and family.
Of these traditional interventions, nutritional support is key to prevention and treatment of pressure ulcers, says Bergquist-Beringer. While all of these interventions can be effective, home health agencies did not always apply them consistently, she admits. Another item that Bergquist-Beringer will be looking at during the study is identifying best practices that can be shared with other agencies. "If some agencies are successful at improving nutritional support or achieving patient and family compliance for repositioning, descriptions of how they accomplished these successes will help everyone," she says.
Data collection for this study is scheduled to last two years, with analysis of the data following, says Wipf. This is a good time to focus on pressure ulcer treatment, she says. "In previous research, many agencies did not have policies and procedures for thorough skin assessment, but with OBQI and pay-for-performance requirements, agencies are now developing these strategies to prevent complications such as pressure ulcers and re-hospitalizations."
1. American Medical Directors Association. Pressure ulcer prevalence and cost in the U.S. Population. JAMDA 2007; 8:B20.
2. Huang L, Rosati R, Ptaszek A. Utilization of skilled nursing visits among home health care recipients with pressure ulcers. Abstr Acad Health Serv Res Health Policy Meet 2002; 19:7.