Geriatric syndromes as outcome measures of hospital care: can administrative data be used?
OBJECTIVE
To determine how often hospital administrative databases capture the occurrence of two common geriatric syndromes, pressure ulcers and incontinence.


METHODS
Retrospective comparison of a nursing home and hospital database.


METHODS
Department of Veterans Affairs (VA) hospitals.


METHODS
All patients between 1992 and 1996 discharged from VA acute medical care and admitted to a VA nursing home.


METHODS
The presence of incontinence or a pressure ulcer (stage 2 or larger) on admission to the nursing home was determined. Hospital discharge diagnoses were then reviewed to determine whether these conditions were recorded. The effect of ulcer stage, total number of discharge diagnoses, and temporal trends on the recording of these conditions in discharge diagnoses was also noted.


RESULTS
There were 17,004 admissions to nursing homes from acute care in 1996; 12.7% had a pressure ulcer and 43.4% were incontinent. Among these patients with a pressure ulcer, the hospital discharge diagnosis listed an ulcer in 30.8% of cases, and incontinence was included correctly as a discharge diagnosis in 3.4%. While deeper pressure ulcers were more likely to be recorded than superficial ulcers (P < .01), nearly 50% of stage 4 ulcers were not listed among hospital discharge diagnoses. Patients with more discharge diagnoses were more likely to record both conditions correctly. From 1992 to 1996, small but significant (P = .001) improvements were noted in the correct recording of these geriatric syndromes as discharge diagnoses.


CONCLUSIONS
The occurrence of pressure ulcers and incontinence cannot be determined from hospital administrative databases and should not be used as outcomes when measuring quality of care among hospitalized patients.
Berlowitz
D R
DR
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Hospital, MA 01730, USA.
Brand
H K
HK
Perkins
C
C
D000368:Aged; D000369:Aged, 80 and over; D003628:Database Management Systems; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006751:Hospital Information Systems / Q000592:standards* / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000453:epidemiology*; D012189:Retrospective Studies; D013577:Syndrome; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology*