Nationwide Trends in Hospital-Acquired Pressure Ulcers, 2018-2024.

Area of Science:

• Healthcare Management
• Patient Safety
• Epidemiology

Background:

• Hospital-acquired pressure ulcers (HAPUs) represent a significant patient safety concern with limited national data in Italy.
• Understanding temporal trends and regional variations is crucial for targeted quality improvement initiatives.

Purpose of the Study:

• To estimate the national incidence, temporal trends, and regional variability of HAPUs in Italy from 2018 to 2024.
• To utilize age-adjusted models and regional estimates for a comprehensive analysis.

Main Methods:

• A retrospective nationwide observational study using Italian Hospital Discharge Records (SDOs) for adult patients (≥18 years) with hospital stays ≥5 days.
• Exclusion of pre-existing pressure ulcers and specific MDC/DRG categories based on adapted AHRQ PSI 03 specifications.
• Estimation of crude and age-adjusted HAPU rates per 10,000 eligible discharges using logistic regression.

Main Results:

• Eligible hospitalizations decreased from 2018 to 2020, then increased. Coded HAPU events showed a decrease followed by an increase during the study period.
• Age-adjusted national rates fluctuated between 13.5 and 21.3 per 10,000 eligible discharges, with a dip in 2020-2021.
• Significant regional variability was observed, with notably lower rates in Friuli Venezia Giulia and Toscana, and higher rates in Lazio and Abruzzo.

Conclusions:

• This study provides the first descriptive overview of temporal and regional variability in coded HAPU events in Italy using administrative data.
• Findings suggest administrative data can be an exploratory source for studying nursing-sensitive outcomes and patient safety indicators.
• Integration of such indicators into national monitoring systems could support benchmarking and evaluation of preventive practices.