Evaluating and improving pressure ulcer care: the VA experience with administrative data.
BACKGROUND
A number of state initiatives are using databases originally developed for nursing home reimbursements to assess the quality of care. Since 1991 the Department of Veterans Affairs (VA; Washington, DC) has been using a long term care administrative database to calculate facility-specific rates of pressure ulcer development. This information is disseminated to all 140 long term care facilities as part of a quality assessment and improvement program.
Assessments are performed on all long term care residents on April 1 and October 1, as well as at the time of admission or transfer to a long term care unit. Approximately 18,000 long term care residents are evaluated in each six-month period; the VA rate of pressure ulcer development is approximately 3.5%. Reports of the rates of pressure ulcer development are then disseminated to all facilities, generally within two months of the assessment date.
The VA's more than five years' experience in using administrative data to assess outcomes for long term care highlights several important issues that should be considered when using outcome measures based on administrative data. These include the importance of carefully selecting the outcome measure, the need to consider the structure of the database, the role of case-mix adjustment, strategies for reporting rates to small facilities, and methods for information dissemination.


CONCLUSIONS
Attention to these issues will help ensure that results from administrative databases lead to improvements in the quality of care.
Berlowitz
D R
DR
Health Services Research and Development Field Program, Bedford Veterans Affairs Hospital, MA 01730, USA. berlowitz.d@bedford.va.gov
Halpern
J
J
D003627:Data Interpretation, Statistical; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D007255:Information Services; D008134:Long-Term Care / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D011159:Population Surveillance; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs