title: Are Evidence-based Practices Associated With Effective Prevention of Hospital-acquired Pressure Ulcers in US Academic Medical Centers?
abstract: BACKGROUND
  In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention.
  
  
  OBJECTIVE
  To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates.
  
  
  METHODS
  We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 University HealthSystem Consortium hospitals between 2007 and 2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding, and QI on HAPU rates. The models assumed level-2 random intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence.
  
  
  RESULTS
  Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (-1.86 cases/quarter; P=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (-11.32 cases/quarter; P<0.001).
  
  
  CONCLUSIONS
  HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care.
authors.affiliation: *Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD†Department of Public Health Sciences, University of Chicago, Chicago, IL‡Department of Clinical Pharmacy§College of Nursing, University of Colorado, Aurora, CO∥Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH¶Departments of Anesthesiology, Critical Care and Surgery, Johns Hopkins School of Medicine, Baltimore, MD#Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: William V
authors.initials: WV
authors.lastname: Padula
authors.forename: Robert D
authors.initials: RD
authors.lastname: Gibbons
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Valuck
authors.forename: Mary B F
authors.initials: MB
authors.lastname: Makic
authors.forename: Manish K
authors.initials: MK
authors.lastname: Mishra
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000293:Adolescent; D000328:Adult; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D055317:Evidence-Based Practice / Q000458:organization & administration*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000517:prevention & control*; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult