Report Cards for Hospital-Acquired Bedsores: How Good are the Grades?

The data Medicare uses to publicly report hospital rates of patients developing pressure ulcers is not an accurate source for comparing hospitals on how well they prevent the condition, says a new University of Michigan study.

Bedsores are skin wounds often caused by pressure against the skin when staying in one position for too long. They are among many common hospital-acquired conditions Medicares Hospital Compare website reports in an effort to help consumers compare the quality of their care at different hospitals.

Hospital bedsore rates varied widely based on how the data was collected, unfairly making some hospitals appear to fare better or worse than others, according to the findings that appear in the Annals of Internal Medicine.

We found drastic differences in performance for bedsore 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, says lead author Jennifer Meddings, MD, MSc, an assistant professor in the Department of Internal Medicine, Division of General Medicine at U-M Medical School. This raises significant concerns about how accurately hospitals are being compared to each other, as this information is reported to the public and may lead to financial penalties for hospitals that seem to be doing poorly.

Overall, bedsore rates were about 10 times lower when they were based on billing data compared to rates calculated from bedside exams by nurses. In bedside exams, trained teams of independent nurses record rates by periodically evaluating patients for bedsores through a comprehensive skin exam. In contrast, hospital-acquired pressure ulcer cases are identified by hospital coders generating billing data based on how physicians and wound care teams describe wounds in their medical record notes.

Our findings provide a strong case for removing hospital rates for pressure ulcers from the Medicares Hospital Compare website in order to prevent comparisons that may be misleading to patients and policymakers, Meddings says.
Additional authors of the study are Heidi Reichert, MA, Tim Hofer, MD, MSc and Laurence McMahon, Jr., MD, MPH, all of U-M. McMahon is the chair of U-M general medicine.

Funding for this study was provided by the Agency for Healthcare Research and Quality.

Reference: Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good are the Grades?  Ann Intern Med. Volume 159, No.8. Oct.15, 2013. 

Source: University of Michigan Health System