Racial Disparities in Rates of Pressure Ulcers in Nursing Homes and Site of Care

Bergstrom N, Horn SD. — Wed, 13 Jul 2011 00:00:00 GMT

Pressure ulcer reduction has been a top priority in health care for at least 40 years, and numerous publicly and privately funded efforts to reduce pressure ulcers have emerged. The Institute of Medicine, the Joint Commission, the Institute for Healthcare Improvement through the 5 Million Lives Campaign, the National Patient Safety Initiative under the Centers for Medicare & Medicaid Service's 9th Scope of Work, and the Advancing Excellence in America's Nursing Homes Campaign have all stimulated efforts to improve quality in the last decade. Early efforts focused on quality improvement in individual facilities, while more recent efforts have focused on collaboration across facilities and states through networks. Public reporting of outcomes such as pressure ulcer incidence and prevalence are used to keep the problem at the forefront of health care improvement initiatives and to track progress.

Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents

Li Y, Yin J, Cai X, et al. — Wed, 13 Jul 2011 00:00:00 GMT

Context

A variety of nursing home quality improvement programs have been implemented during the last decade but their implications for racial disparities on quality are unknown.

Objectives

To determine the longitudinal trend of racial disparities in pressure ulcer prevalence among high-risk, long-term nursing home residents and to assess whether persistent disparities are related to where residents received care.

Design, Setting, and Participants

Observational cohort study of pressure ulcer rates in 2.1 million white and 346 808 black residents of 12 473 certified nursing homes in the United States that used the nursing home resident assessment; Online Survey, Certification, and Reporting files; and Area Resource Files for 2003 through 2008. Nursing homes were categorized according to their proportions of black residents.

Main Outcome Measures

Risk-adjusted racial disparities between and within sites of care and risk-adjusted odds of pressure ulcers in stages 2 through 4 for black and white residents receiving care in different nursing home facilities.

Results

Pressure ulcer rates decreased overall from 2003 through 2008 but black residents of nursing homes showed persistently higher pressure ulcer rates than white residents. In 2003, the pressure ulcer rate was 16.8% (95% confidence interval [CI], 16.6%-17.0%) for black nursing home residents compared with 11.4% (95% CI, 11.3%-11.5%) for white residents; in 2008, the rate was 14.6% (95% CI, 14.4%-14.8%) compared with 9.6% (95% CI, 9.5%-9.7%), respectively (P >.05 for trend of disparities). In nursing homes with the highest percentages of black residents (≥35%), both black residents (unadjusted rate of 15.5% [95% CI, 15.2%-15.8%] in 2008; adjusted odds ratio [AOR], 1.59 [95% CI, 1.52-1.67]) and white residents (unadjusted rate of 12.1% [95% CI, 11.8%-12.4%]; AOR, 1.33 [95% CI, 1.26-1.40]) had higher rates of pressure ulcers than nursing homes serving primarily white residents (concentration of black residents <5%), in which white residents had an unadjusted rate of 8.8% (95% CI, 8.7%-8.9%).

Conclusions

From 2003 through 2008, the prevalence of pressure ulcers among high-risk nursing home residents was higher among black residents than among white residents. This disparity was in part related to the site of nursing home care.

JAMA: Pressure Ulcers Topic Collection

Racial Disparities in Rates of Pressure Ulcers in Nursing Homes and Site of Care

Association of Race and Sites of Care With Pressure Ulcers in High-Risk Nursing Home Residents