The minimum data set pressure ulcer indicator: does it reflect differences in care processes related to pressure ulcer prevention and treatment in nursing homes?
OBJECTIVE
To determine whether nursing homes (NHs) that score in the extreme quartiles of pressure ulcer (PU) prevalence as reported on the Minimum Data Set (MDS) PU quality indicator provide different PU care.


METHODS
Descriptive, cohort.


METHODS
Sixteen NHs.


METHODS
Three hundred twenty-nine NH residents at risk for PU development as determined by the PU Resident Assessment Protocol of the MDS.


METHODS
: Sixteen care process quality indicators (10 specific to PU care processes, five related to nutrition, and one related to incontinence management) were scored using medical record data, direct human observation, interviews, and data from wireless thigh movement monitors.


RESULTS
There were no differences between homes with low- and high-PU prevalence rates reported on the MDS PU quality indicator on most care processes. NHs with high PU prevalence rates used pressure-reduction surfaces more frequently and were better at documentation of four wound characteristics when PUs were present. No measure of PU care processes was better in low-PU NHs. Neither low- nor high-PU prevalence NHs routinely repositioned residents every 2 hours, even though 2-hour repositioning was documented in the medical record for nearly all residents.


CONCLUSIONS
The assumption that homes with fewer PUs and thus low PU prevalence according to the MDS PU quality indicator are providing better PU care was not supported in this sample. NHs that scored low on the MDS PU quality indicator did not provide significantly better care than NHs that scored high. All NHs could improve PU prevention, as evidenced by the poor performance on prevention care processes by low- and high-PU NHs. The MDS PU quality indicator is not a useful measure of the quality of PU care in NHs and can be misleading if not presented with an explanation of the meaning of the indicator.
Bates-Jensen
Barbara M
BM
Division of Geriatrics, School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. batesjen@ucla.edu
Cadogan
Mary
M
Osterweil
Dan
D
Levy-Storms
Lené
L
Jorge
Jennifer
J
Al-Samarrai
Nahla
N
Grbic
Valena
V
Schnelle
John F
JF
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D008991:Monitoring, Physiologic; D009068:Movement; D009735:Nursing Homes / Q000592:standards*; D019370:Observation; D011187:Posture; D003668:Pressure Ulcer / Q000453:epidemiology / Q000451:nursing / Q000517:prevention & control*; D015995:Prevalence; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013848:Thigh; D013997:Time Factors