Administrative Memos

199905

FROM: Theodore O. Will, Chief Executive Officer
DATE: May 11, 1999
SUBJECT: Impact Results of a Statewide Effort to Improve Pressure Ulcer Prevention in New York State
IPRO CONTACTS:

Charles Stimler, M.D., M.P.H., Clinical Coordinator, Ext. 514

Enclosed please find a report entitled "Impact Results of a Statewide Effort to Improve Pressure Ulcer Prevention". This reports on the final phase of a quality improvement study which began in 1995 with the participation of approximately 60 acute care hospitals across New York State. IPRO furnished these hospitals with their baseline rates of processes-of-care related to pressure ulcer prevention and sent a statewide report on the aggregate results to all hospitals in July, 1996. Following this, collaborators participated in numerous interventions designed to improve the quality of care their patients received. Among these was the development and dissemination of a "toolkit" designed by IPRO which contained guidelines, risk assessment tools, promotional items, and educational material.

This final impact report documents significant improvements in many of the quality indicators. The percentage of patients that received a standardized risk assessment increased from 56% to 76%, and the number of patients who received re-assessments increased from 37% to 50%. There was a consistent increase across all categories of clinical interventions designed to prevent pressure ulcers. Further details of all results are presented in the enclosed report.

Should you have any questions about IPRO's "Impact Results of a Statewide Effort to Improve Pressure Ulcer Prevention in New York State" project or report, please feel free to contact Charles Stimler, M.D., M.P.H., Clinical Coordinator, at extension 514.

EXECUTIVE SUMMARY

Pressure ulcers are an important health concern for all patients with limited mobility and activity levels; the problem costs the United States over one billion dollars annually. Prevention is the most cost effective approach for dealing with this problem. The Agency for Health Care Policy and Research's (AHCPR) 1992 Clinical Practice Guideline provides clear and concise recommendations for the prevention of pressure ulcers. This Guideline recommends identifying patients "potentially at risk" for developing pressure ulcers and then providing them with a standardized risk assessment. Those patients who are determined to be actually "at risk" on the basis of this assessment should then receive interventions to prevent pressure ulcers. In addition, patients and their families should be educated about pressure ulcer prevention. There is growing evidence in the medical literature that this Guideline provides a clinically effective strategy to reduce the prevalence of pressure ulcers in a wide variety of patient settings.

In July, 1996 IPRO released a baseline study which measured the quality of care provided to hospital inpatients admitted with the principal diagnosis of cerebrovascular accident (CVA) regarding the prediction and prevention of pressure ulcers . This current IPRO impact study is a follow-up study which was performed to assess the degree to which various IPRO and hospital based interventions affected this aspect of care. The baseline study involved the abstraction of 1,253 medical records from 62 collaborating hospitals throughout New York State for patients discharged during 1994 with the diagnosis of CVA. The impact study involved the abstraction of 721 medical records from 59 collaborating hospitals that completed the study for CVA patients discharged in the last quarter of 1997.

The results demonstrated improvements in all clinical areas studied and among all the quality indicators. The percentage of patients that received a standardized risk assessment increased from 56% to 76%, and the proportion of patients who received re-assessments increased from 37% to 50%. Clinical interventions performed to prevent pressure ulcers among patients Aat risk@ consistently increased across the board including patient re-positioning (from 29% to 58%), pressure relief (27% to 62%), moisture control (from 51% to 73%), shear/friction reduction (from 19% to 46%), and nutritional interventions (from 97% to 99%). The rate at which education was provided to patients/families at risk increased from 7% to 17%.

Although the study was not designed to evaluate outcomes, a downward trend in the incidence of new pressure ulcers was noted since the baseline measurement. The development of pressure ulcers after admission occurred in 18% of all cases in the baseline sample and in 7% of all cases in the impact sample.

The success of this project was attributed to a combination of factors: enthusiastic participation by collaborating hospitals, close working relationships between the hospitals and IPRO, and the use of a "toolkit" developed by IPRO which offered a wide variety of potential applications for hospitals, including copies of guidelines, risk assessment tools, educational materials for staff and patients, posters, and administrative aids.