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Published on: March 9, 2019
Examining Social Risk Factors in a Pressure Ulcer Quality Measure for Three Post-Acute Care Settings.
Julie Seibert1, Daniel Barch, Amarilys Bernacet
1At RTI International, Research Triangle Park, North Carolina, Julie Seibert, PhD, MPH, is Senior Research Public Health Analyst; Daniel Barch, PhD, is Research Public Health Analyst; Amarilys Bernacet, MPH, is Research Public Health Analyst; Amy Kandilov, PhD, MA, is Senior Research Economist; Jennifer Frank, MPH, is Research Public Health Analyst; Lindsey Free, BA, and Quantesa Roberts, MA, are former Public Health Analysts; Karen Reilly, ScD, is formerly Senior Health Policy Researcher; and Laura Smith, PhD, is Program Director, Quality Measurement and Health Policy Program. At the CMS in Baltimore, Maryland, Tara McMullen, PhD, is a Technical Advisor, and Alan Levitt, MD, is a Medical Officer. At the Office of the Assistant Secretary for Planning and Evaluation in Washington, DC, Stella Mandl, BSN, RN, is the Physician-Focused Payment Model Technical Advisory Committee Staff Director. Acknowledgments: The authors would like to acknowledge Yevgeniya Kaganova, Kent Parks, and Scott Scheffler of RTI for their invaluable assistance with statistical programming. Support for this evaluation came from the CMS, under contract number HHSM-500-2013-13015I. The statements contained in this presentation are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors have disclosed no other financial relationships related to this article. Submitted August 12, 2019; accepted in revised form September 24, 2019; published online ahead of print January 7, 2020.
Disparities in pressure ulcer incidence exist across post-acute care settings. Black race, male sex, and older age predict higher risks, though health conditions can reduce racial disparities.
Area of Science:
- Healthcare Quality
- Patient Safety
- Gerontology
Background:
- Pressure ulcers are a significant concern in post-acute care (PAC).
- Sociodemographic factors may influence pressure ulcer development.
- Understanding these relationships is crucial for improving patient outcomes.
Purpose of the Study:
- To examine the relationship between sociodemographic factors and the incidence or worsening of pressure ulcers.
- To explore these relationships across different PAC settings.
Main Methods:
- Analysis of Medicare Part A residents and patients in PAC facilities in 2015.
- Stratification of pressure ulcer incidence by patient race and sex.
- Logistic and multiple regression modeling to assess risk and facility-level factors.
Main Results:
- Significant differences in pressure ulcer incidence were found across all three PAC settings (skilled nursing facilities, inpatient rehabilitation facilities, long-term care hospitals).
- Black race, male sex, and advanced age were significant predictors of new or worsened pressure ulcers.
- Controlling for health conditions reduced the observed racial disparity. Facility ownership, location, and patient demographics also influenced rates.
Conclusions:
- Evidence suggests disparities in pressure ulcer incidence across PAC settings.
- Publicly available quality data can be utilized to identify and address these disparities.
- Targeted interventions may help ameliorate pressure ulcer problems in vulnerable populations.
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