Developing risk-adjusted quality indicators for pressure ulcers in long-term care hospitals in the Republic of Korea

Pressure ulcers result in financial losses, including the cost of unnecessary medical expenses because of extended hospital stays, treatment, and examination. This was a retrospective, observational, methodological study to develop quality indicators related to pressure ulcer development and validate risk adjustment factors for pressure ulcer development. We performed a literature review to develop risk adjustment factors, and an expert group performed a content validity test. To validate risk adjustment factors for pressure ulcer development using electronic medical records, 127 patients admitted to a long-term care hospital in South Korea from June to September 2015 were enrolled in the study. Pressure ulcer risk factors were peripheral vascular disease, end-stage disease, past pressure ulcer history, high risk group for pressure ulcer development, fever, haemoglobin, and albumin (all P < 0.05); only albumin (odds ratio: 0.210, P < 0.001) was significantly associated with pressure ulcer development as an independent risk factor. Further research with a large sample size is needed for the validation of risk adjustment factors. Risk-adjusted quality indicators for pressure ulcer development can be used to evaluate the quality of nursing care and compare outcomes after preventive pressure ulcer care activities or between long-term care hospitals.