Hospital bedsores linked to patient mortality

The research is believed to be the first of its kind to use data directly from medical records to assess the impact of hospital-acquired pressure ulcers on Medicare patients at national and state levels.

According to the study, featured as the lead article in the current issue of the Journal of the American Geriatrics Society, seniors who developed pressure ulcers were more likely to die during their hospital stay, to have longer stays in the hospital, and to be readmitted to the hospital within 30 days of their discharge.

To arrive at their findings, the researchers tracked more than 51,000 randomly selected Medicare beneficiaries hospitalized across the United States in 2006 and 2007.

"Hospital-acquired pressure ulcers were shown to be an important risk factor associated with mortality," said Dr. Courtney Lyder, lead investigator on the study and dean of the UCLA School of Nursing. "It is incumbent upon hospitals to identify individuals at high risk for these ulcers and implement preventive interventions immediately upon admission."

According to Lyder and his research team, individuals at the highest risk are those with existing chronic conditions, such as congestive heart failure, pulmonary disease, cardiovascular disease, diabetes and obesity, as well as those on steroids.

In conducting the study, the researchers were challenged by the fact that there is no large single database to help determine the incidence of pressure ulcers among hospitalized Medicare patients. They therefore culled their data from Medicare's claim history, a national surveillance system designed to identify adverse events -- or "unintended harm" -- within the hospitalized Medicare population. The researchers looked at this data to determine the cause and patterns of hospital-acquired pressure ulcers.

The study found that 4.5 percent of the patients tracked acquired a pressure ulcer during their stay in the hospital. The majority of these bedsores were found on the tailbone or sacrum, followed by the hip, buttocks and heels. The study also revealed that of the nearly 3,000 individuals who entered the hospital with a pressure ulcer, 16.7 percent developed at least one new bedsore on a different part of their body during their hospitalization.

"This is a serious issue, and now we have data that can help the health care system address this ongoing problem," Lyder said. "When individuals enter the hospital with the risk conditions that we've identified, it should send up an immediate warning signal that appropriate steps should be taken to minimize the chance of pressure ulcers occurring."

In addition to Lyder, clinical researchers on this study included Yun Wang of Qualidigm, the Centers for Outcomes Research and Evaluation at Yale University, and Yale-New Haven Health; Mark Metersky of Qualidigm and the division of pulmonary and critical care medicine at the University of Connecticut School of Medicine; Maureen Curry of Qualidigm; Rebecca Kliman of the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services; Nancy Verzier of Qualidigm; and David Hunt of the Office of Health Information Technology Adoption in the Office of the National Coordinator for Health Information Technology.

The study was funded by the Centers for Medicare and Medicaid Services.