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American Journal of Medical Quality
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Using the Case Mix of Pressure Ulcer Healing to Evaluate Nursing Home Performance

Alok Kapoor, MD, MSc

Hospital Medicine Unit, Section of General Internal Medicine, Boston University, Boston, Massachusetts, alok.kapoor{at}BMC.org

Boris Kader, PhD

\Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts

Howard Cabral, PhD, MPH

Department of Biostatistics, Boston University, Boston, Massachusetts

Arlene S. Ash, PhD

Health Care Research Unit, Section of General Internal Medicine, Boston University, Boston, Massachusetts

Dan Berlowitz, MD, MPH

Section of General Internal Medicine, Boston University, Boston, Massachusetts and Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, Massachusetts

Pressure ulcer healing is an important quality measure for nursing homes, but the factors that predict healing have not been well studied. Using the Minimum Data Set, the authors identified candidate variables for a logistic regression, risk-adjustment model to predict ulcer healing. The authors then assessed model discrimination and calibration. Finally, the authors compared unadjusted with risk-adjusted performance for the individual facilities within a nursing home chain. Significant predictors of healing included mobility in bed, presence of a stage 2 ulcer (compared with a stage 4 ulcer), absence of paraplegia and quadriplegia, and absence of end-stage illness. The model C statistic was 0.67, and the calibration was acceptable. Judgments about nursing performance varied in 2 cases depending upon whether unadjusted or risk-adjusted performance was used. The model that the authors developed contains credible predictors of healing. Pressure ulcer healing may be one of many indicators used to evaluate nursing home quality. (Am J Med Qual 2008; 23:342-349)

Key Words: risk adjustment • pressure ulcer healing • nursing home

This version was published on September 1, 2008

American Journal of Medical Quality, Vol. 23, No. 5, 342-349 (2008)
DOI: 10.1177/1062860608316109
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