title: Are we improving the quality of nursing home care: the case of pressure ulcers.
abstract: BACKGROUND
  There are widespread concerns regarding the quality of nursing home care and whether care is improving. We evaluated a large provider of nursing home care to determine whether risk-adjusted rates of pressure ulcer development have changed.
  
  
  METHODS
  We used the Minimum Data Set to study National HealthCare Corporation nursing homes from 1991 through 1995. Rates of pressure ulcer development were calculated for successive 6-month periods by determining the proportion of residents initially ulcer-free having a stage 2 or larger pressure ulcer on subsequent assessments. Rates were risk-adjusted for patient characteristics. The proportion of new ulcers that were deep (stages 3 or 4) were also calculated.
  
  
  RESULTS
  We examined risk-adjusted rates of pressure ulcer development based on 144,379 observations of 30,510 residents at 107 nursing homes. The number of observations per 6-month period ranged from 11,041 to 15,805. Between 1991 and 1995, there was a significant (P<.05) rate decline of more than 25%. Additionally, the proportion of new ulcers that were stages 3 or 4 declined from 30 to 22% (P<.01).
  
  
  CONCLUSIONS
  Nursing homes showed significant improvement in the quality of pressure ulcer preventive care from 1991 to 1995.
authors.affiliation: Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Berlowitz
authors.forename: H Q
authors.initials: HQ
authors.lastname: Bezerra
authors.forename: G H
authors.initials: GH
authors.lastname: Brandeis
authors.forename: B
authors.initials: B
authors.lastname: Kader
authors.forename: J J
authors.initials: JJ
authors.lastname: Anderson
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016014:Linear Models; D008297:Male; D009735:Nursing Homes / Q000592:standards* / Q000639:trends; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D011237:Predictive Value of Tests; D003668:Pressure Ulcer / Q000145:classification / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015144:Southeastern United States / Q000453:epidemiology