title: Using the case mix of pressure ulcer healing to evaluate nursing home performance.
abstract: Pressure ulcer healing is an important quality measure for nursing homes, but the factors that predict healing have not been well studied. Using the Minimum Data Set, the authors identified candidate variables for a logistic regression, risk-adjustment model to predict ulcer healing. The authors then assessed model discrimination and calibration. Finally, the authors compared unadjusted with risk-adjusted performance for the individual facilities within a nursing home chain. Significant predictors of healing included mobility in bed, presence of a stage 2 ulcer (compared with a stage 4 ulcer), absence of paraplegia and quadriplegia, and absence of end-stage illness. The model C statistic was 0.67, and the calibration was acceptable. Judgments about nursing performance varied in 2 cases depending upon whether unadjusted or risk-adjusted performance was used. The model that the authors developed contains credible predictors of healing. Pressure ulcer healing may be one of many indicators used to evaluate nursing home quality.
authors.affiliation: Hospital Medicine Unit, Section of General Internal Medicine, Boston University, Boston, Massachusetts, USA. alok.kapoor@BMC.org
authors.forename: Alok
authors.initials: A
authors.lastname: Kapoor
authors.forename: Boris
authors.initials: B
authors.lastname: Kader
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
mesh_terms: D000367:Age Factors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D010243:Paralysis; D003668:Pressure Ulcer / Q000628:therapy*; D019984:Quality Indicators, Health Care; D012720:Severity of Illness Index; D012737:Sex Factors; D019452:Terminally Ill; D014945:Wound Healing