title: Pressure ulcers in elderly patients with hip fracture across the continuum of care.
abstract: OBJECTIVE
  To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged.
  
  
  METHODS
  Hip fracture patients aged 65 and older who underwent surgery for hip fracture.
  
  
  METHODS
  A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission.
  
  
  RESULTS
  In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3-3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1-4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8-2.3) and 1.3 (95% CI=0.8-2.1), respectively.
  
  
  CONCLUSIONS
  Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School ofMedicine, 660W. Redwood Street, Suite 200, Baltimore, MD 21201, USA. mbaumgar@epi.umaryland.edu
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.forename: Denise L
authors.initials: DL
authors.lastname: Orwig
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Shardell
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkes
authors.forename: Patricia
authors.initials: P
authors.lastname: Langenberg
authors.forename: Mary H
authors.initials: MH
authors.lastname: Palmer
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Jones
authors.forename: Patrick F
authors.initials: PF
authors.lastname: McArdle
authors.forename: Robert
authors.initials: R
authors.lastname: Sterling
authors.forename: Bruce P
authors.initials: BP
authors.lastname: Kinosian
authors.forename: Shayna E
authors.initials: SE
authors.lastname: Rich
authors.forename: Janice
authors.initials: J
authors.lastname: Sowinski
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D003266:Continuity of Patient Care; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors