title: Comparative effectiveness of quality improvement interventions for pressure ulcer prevention in academic medical centers in the United States.
abstract: BACKGROUND
  Prevention of pressure ulcers, one of the hospital-acquired conditions (HACs) targeted by the 2008 nonpayment policy of the Centers for Medicare & Medicaid Services (CMS), is a critical issue. This study was conducted to determine the comparative effectiveness of quality improvement (QI) interventions associated with reduced hospital-acquired pressure ulcer (HAPU) rates.
  
  
  METHODS
  In an quasi-experimental design, interrupted time series analyses were conducted to determine the correlation between HAPU incidence rates and adoption of QI interventions. Among University HealthSystem Consortium hospitals, 55 academic medical centers were surveyed from September 2007 through February 2012 for adoption patterns of QI interventions for pressure ulcer prevention, and hospital-level data for 5,208 pressure ulcer cases were analyzed. Between- and within-hospital reduction significance was tested with t-tests post-CMS policy intervention.
  
  
  RESULTS
  Fifty-three (96%) of the 55 hospitals used QI interventions for pressure ulcer prevention. The effect size analysis identified five effective interventions that each reduced pressure ulcer rates by greater than 1 case per 1,000 patient discharges per quarter: leadership initiatives, visual tools, pressure ulcer staging, skin care, and patient nutrition. The greatest reductions in rates occurred earlier in the adoption process (p<.05).
  
  
  CONCLUSIONS
  Five QI interventions had clinically meaningful associations with reduced stage III and IV HAPU incidence rates in 55 academic medical centers. These QI interventions can be used in support of an evidence-based prevention protocol for pressure ulcers. Hospitals can not only use these findings from this study as part of a QI bundle for preventing HAPUs.
authors.affiliation: Section of Hospital Medicine, University of Chicago, USA.
authors.forename: William V
authors.initials: WV
authors.lastname: Padula
authors.forename: Mary Beth F
authors.initials: MB
authors.lastname: Makic
authors.forename: Manish K
authors.initials: MK
authors.lastname: Mishra
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001364:Awareness; D001513:Beds; D019985:Benchmarking; D057186:Comparative Effectiveness Research; D003953:Diagnosis-Related Groups; D057286:Electronic Health Records; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D015994:Incidence; D007318:Inservice Training / Q000458:organization & administration; D065186:Interrupted Time Series Analysis; D007857:Leadership; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control*; D058996:Quality Improvement / Q000458:organization & administration*; D017592:Skin Care / Q000451:nursing; D014481:United States; D055815:Young Adult