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Geriatric syndromes as outcome measures of hospital care: can administrative data be used?
D R Berlowitz1, H K Brand, C Perkins
1Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, MA 01730, USA.
Objective:
To determine how often hospital administrative databases capture the occurrence of two common geriatric syndromes, pressure ulcers and incontinence.
Design:
Retrospective comparison of a nursing home and hospital database.
Setting:
Department of Veterans Affairs (VA) hospitals.
Participants:
All patients between 1992 and 1996 discharged from VA acute medical care and admitted to a VA nursing home.
Measurements:
The presence of incontinence or a pressure ulcer (stage 2 or larger) on admission to the nursing home was determined. Hospital discharge diagnoses were then reviewed to determine whether these conditions were recorded. The effect of ulcer stage, total number of discharge diagnoses, and temporal trends on the recording of these conditions in discharge diagnoses was also noted.
Results:
There were 17,004 admissions to nursing homes from acute care in 1996; 12.7% had a pressure ulcer and 43.4% were incontinent. Among these patients with a pressure ulcer, the hospital discharge diagnosis listed an ulcer in 30.8% of cases, and incontinence was included correctly as a discharge diagnosis in 3.4%. While deeper pressure ulcers were more likely to be recorded than superficial ulcers (P < .01), nearly 50% of stage 4 ulcers were not listed among hospital discharge diagnoses. Patients with more discharge diagnoses were more likely to record both conditions correctly. From 1992 to 1996, small but significant (P = .001) improvements were noted in the correct recording of these geriatric syndromes as discharge diagnoses.
Conclusions:
The occurrence of pressure ulcers and incontinence cannot be determined from hospital administrative databases and should not be used as outcomes when measuring quality of care among hospitalized patients.