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Evaluating and improving pressure ulcer care: the VA experience with administrative data
1Health Services Research and Development Field Program, Bedford Veterans Affairs Hospital, MA 01730, USA. berlowitz.d@bedford.va.gov
The Joint Commission Journal on Quality Improvement
|August 1, 1997
Summary
The Department of Veterans Affairs uses administrative data to track pressure ulcer development in long-term care facilities, informing quality improvement initiatives. This approach highlights key considerations for using such data effectively.
Area of Science:
- Health Services Research
- Quality Improvement Science
- Geriatric Care
Background:
- State initiatives increasingly use reimbursement databases for quality assessment.
- The Department of Veterans Affairs (VA) has utilized a long-term care administrative database since 1991.
- This database calculates facility-specific pressure ulcer development rates for quality improvement.
Purpose of the Study:
- To evaluate the VA's experience using administrative data for quality assessment in long-term care.
- To identify critical issues in using outcome measures derived from administrative databases.
Main Methods:
- Utilized a long-term care administrative database for outcome assessment.
- Collected data on pressure ulcer development rates across 140 VA facilities.
- Disseminated facility-specific rates as part of a quality assessment and improvement program.
Main Results:
- Approximately 18,000 long-term care residents are evaluated biannually.
- The VA's overall pressure ulcer development rate is approximately 3.5%.
- Rates are disseminated to facilities within two months of assessment.
Conclusions:
- Using administrative data for quality assessment requires careful selection of outcome measures.
- Considerations include database structure, case-mix adjustment, and reporting strategies for small facilities.
- Effective information dissemination is crucial for improving long-term care quality.