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Medicare data may underestimate pressure ulcer problem

There are different criteria that consumers may examine when trying to compare Medicare-eligible hospitals. They may study the caliber of doctors on staff, the medical technology onsite or overall patient satisfaction. The quality of inpatient care is also important, and the prevention of hospital-acquired pressure ulcers may factor into that. Without reliable pressure ulcer data, consumers and their loved ones are at a loss.

The official website for Medicare compiles information on several hospital-acquired conditions and makes this information available for review. However, new research published in the Annals of Internal Medicine suggests that the data pertaining to pressure ulcers is inaccurate, potentially underestimating the threat posed by these skin lesions.

'We found drastic differences'

To investigate the validity of data collected on hospital-acquired pressure ulcer rates, a team of scientists from the University of Michigan Health System took a closer look at the different ways this information is reported. Generally, there are two main ways hospitals can gather this information. First, independent nurses can record the results of their own comprehensive skin examinations, conducted at the bedside. Second, pressure ulcers are recorded through billing data created by hospital coders who track wound care described in medical records.

In the latter scenario, the reported rates of pressure ulcers may be as much as 10 times lower than those indicated by hospital nurses, which is cause for concern if the actual rates are higher than official ones, therefore underestimating the seriousness of pressure ulcers.

"We found drastic differences in performance for [pressure ulcer] rates depending on which type of data was reviewed - hospitals could be graded as either superior or below average depending on the type of data used," said lead study author Jennifer Meddings, M.D., M.Sc.

Meddings argued that her team's research supports the idea of eliminating this information from Medicare's Hospital Compare website.

Leaders from the Mayo Clinic noted that there are several ways that pressure ulcers can be prevented in the context of hospital care. These include the repositioning of patients every two hours during surgical procedures, the use of special tablepads and support devices to relieve pressure, and protection of bony areas, such as the hips, knees, ankles and heels using gel or foam positioning products. However, if procedures last more than 2.5 hours, or if patients are older or have vascular conditions, it is better to use viscoelastic gel mattresses, which can prevent pressure ulcers in addition to skin changes.