Related Experiment Video
Updated: Apr 18, 2026
Mouse Model of Pressure Ulcers After Spinal Cord Injury
Published on: March 9, 2019
Risk Factors for Development of New or Worsened Pressure Ulcers Among Patients in Inpatient Rehabilitation Facilities
Margaret A DiVita1, Carl V Granger2, Richard Goldstein3
1Health Department, State University of New York at Cortland, Cortland, NY; Uniform Data System for Medical Rehabilitation, Amherst, NY(∗).
Insights
Inpatient rehabilitation facility patients with lower admission Functional Independence Measure (FIM) scores and higher Centers for Medicare and Medicaid Services (CMS) comorbidity tiers face increased risk of developing pressure ulcers.
Area of Science:
- Rehabilitation Medicine
- Quality Improvement
- Patient Safety
Background:
- Pressure ulcers are a new quality indicator for inpatient rehabilitation facilities (IRFs).
- Limited research exists on pressure ulcer risk factors specifically within IRF patient populations.
Purpose of the Study:
- To identify risk factors associated with new or worsened pressure ulcers in IRF patients.
- To inform clinical practice and resource allocation for pressure ulcer prevention.
Main Methods:
- Retrospective cohort study utilizing the Uniform Data System for Medical Rehabilitation database.
- Analysis of 2766 IRF patients with new/worsened pressure ulcers and 190,996 controls.
- Logistic regression examining demographics, impairment type, comorbidities (CMS comorbidity tier), and functional status (FIM instrument).
Main Results:
- Lower admission FIM total score was strongly associated with pressure ulcer development (P <.001).
- Higher CMS comorbidity tier was significantly associated with pressure ulcer development.
- Increased age, male gender, and wheelchair use were also identified as risk factors.
Conclusions:
- Admission FIM total and CMS comorbidity tier are potential tools for identifying IRF patients at risk for pressure ulcers.
- Understanding these risk factors is crucial for individualized care planning and resource management in IRFs.
Background:
Documentation of a new or worsened pressure ulcer is a new, required quality indicator for all inpatient rehabilitation facilities (IRFs) in the United States; however, there is little research regarding risk factors for pressure ulcers among patients seen in IRFs.
Objective:
To examine the risk factors for development of a new or worsened pressure ulcer among patients seen in IRFs.
Design:
A retrospective cohort study.
Setting:
IRFs in the United States.
Participants:
IRF patients more than 18 years of age, with documented new or worsened pressure ulcer during their rehabilitation stay (n = 2766) and IRF patients with no new or worsened pressure ulcer documented from admission to discharge (n = 190,996) discharged October 2008 to September 2011, included in the Uniform Data System for Medical Rehabilitation database.
Methods:
Multiple logistic regression analysis was used to estimate risk factors for the development of a new or worsened pressure ulcer utilizing data captured in the Centers for Medicare and Medicaid Services (CMS) payment document. Examined were demographic variables, including age and gender, medical variables, including impairment type and presence of comorbidities, and functional status, as measured through the Functional Independence Measure (FIM) instrument.
Main Outcome Measures:
Development of a new or worsened pressure ulcer in patients during the rehabilitation stay compared to patients with no documented pressure ulcer or no worsened ulcer.
Results:
Admission FIM total was strongly associated with development of a new or worsened pressure ulcer, P <.001 in analyses of all patients and for each of the 3 impairment-specific groups with the highest rate of ulcer development among spinal cord injury, orthopedic, and amputation cases. CMS comorbidity tier was also significantly associated with ulcers in all models. Other variables that entered one or more models included increased age, male gender, and use of a wheelchair.
Conclusions:
Admission FIM total and CMS comorbidity tier may be useful in the identification of patients at risk for development of new or worsened pressure ulcers in IRFs. Identification of pressure ulcer risk factors has important implications for individual plan-of-care decisions as well as for resource provisions during the rehabilitation stay.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Peripheral Artery Disease IV: Nursing Management
01:31Diabetic Foot Ulcer
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities