Quality-Improvement Project Cuts Worst Pressure Lesions 69%
Kleyman, Paul, Aging Today
A national collaborative project of nursing homes and Medicare's Quality Improvement Organizations (QIOs) successfully reduced the incidence of the most serious pressure ulcers by 69% in one year, according to a new study published in the October 2007 issue of the Journal of the American Geriatrics Society. The findings are particularly striking because the research exposed flaws in the current model for data collection and analysis, the use of which has masked crucial differences between severity stages of pressure lesions.
"Although quality-improvement usually aims to translate insights from research into practice, this project demonstrated the potential for clinical quality improvement collaboratives to inform research priorities," write the report's authors, Joanne Lynn of the Centers for Medicare and Medicaid Services (CMS) and her colleagues.
DANGEROUS BUT PREVENTABLE
The researchers state, "Elderly and disabled persons dread pressure ulcers; they cause pain, limit activity, increase risk of sepsis, degrade self-image and increase the costs and challenges of caregiving." The article, titled "Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing Homes," explains that pressure ulcers range according to the depth in the skin from lighter Stage I sores to potentially Stage IV lesions in which lack of circulation can cause a patient's skin to the and gouge wounds down to bone. As life-threatening as accident injuries, these wounds can be treated if identified in time and, better yet, can be prevented.
Although Stage III and IV pressure lesions generate most of the suffering from such wounds, say the authors, the current quality indicators used to report and assess information from nursing homes about incidences of pressure ulcers combine all stages under the presumption that higher rates of superficial lesions correlate with higher risks of full-thickness ulcers. However, for reasons the study says are yet to be understood, more superficial Stage I and II sores often improve with little or no intervention, whereas deeper Stage III and IV wounds may not. Because the current measure does not differentiate them, though, the rapid improvement of superficial sores tends to obscure the need for aggressive efforts to identify and treat more severe wounds.
"The results of this project challenge some prevailing assumptions," says the study. In addition, the authors write, "Advocates and clinicians have mostly presumed that the rate of deep [pressure sores] (Stage III and IV) correlates with the rate of superficial ones (Stage I and II) and that [pressure sores] progress from less-severe to more-severe lesions. The participants and faculty concluded, as have others, that Stage I and II lesions and Stage III and IV lesions may reflect different causal pathways and, furthermore, that Stage I and II lesions heal quickly and have little correlation with risk for deep lesions."
EXISTING MEASURES FLAWED
Despite major improvement in the worst types of pressure ulcers, says the report, the existing publicly reported measure reflected no improvement. …