Shannon RJ, Brown L, Chakravarthy D, et al.
Advances in skin & wound care. Date of publication 2012 Oct 1;volume 25(10):450-64.
1. Adv Skin Wound Care. 2012 Oct;25(10):450-64.
Pressure Ulcer Prevention Program Study: a randomized, controlled prospective
comparative value evaluation of 2 pressure ulcer prevention strategies in nursing
and rehabilitation centers.
Shannon RJ(1), Brown L, Chakravarthy D.
Author information:
(1)Global Health Economic Projects LLC, Clifton Park, New York, USA.
OBJECTIVE: This article assesses the comparative prevention-effectiveness and
economic implications of a Pressure Ulcer Prevention Program (PUPP) against
standard practice of prevention using Agency for Health Care Policy and Research
(now the Agency for Healthcare Research and Quality [AHRQ]) guidelines and a
mixture of commercial products.
DESIGN: The study is a randomized, controlled, prospective cohort study with an
accompanying economic evaluation. The economic evaluation is performed from the
perspective of the nursing and rehabilitation centers.
SETTINGS: Two nursing and rehabilitation centers under the same quality and
safety support organization. Both institutions are experiencing high nursing
staff turnover and incidence of pressure ulcers (PrUs).
PARTICIPANTS: 133 residents at risk of developing PrUs (EQUIP-for-Quality Risk
Score Moderate to Very High [MVH]). All are Medicare-eligible residents with
Minimum Data Set (MDS) 2.0 evaluations.
INTERVENTIONS: The PUPP includes a strategic product bundle and decision
algorithms driven by MDS 2.0 Resident Assessment Scores to assist in reducing or
preventing PrUs and incontinence-associated skin conditions. The control group
utilizes a different brand and assortment of commercial skin care products,
briefs, pads, and mattresses, but without use of the decision algorithms driven
by MDS 2.0 Resident Assessment Scores. Pressure ulcer prevention education was
done for all nurses by a nurse certified in the PUPP program at the beginning and
ad libitum by trained senior nursing staff at the end of the study.
MAIN OUTCOME MEASURES: Comparative reduction in the incidence of nosocomial PrUs
and average 6-month net cost savings per MVH-risk resident.
METHODS: Residents were assessed for PrU risk using EQUIP-for-Quality risk
assessment algorithm based on data from their Minimum Data Set (MDS 2.0), then
assigned to either the PUPP program or control group (standard practice following
AHRQ guidelines). Residents were followed until discharge, death, development of
PrU, or a maximum time period of 6 months. Direct medical costs of prevention and
PrU treatment were recorded using a modified activity-based costing method. A
decision model was used to estimate the net cost savings attributed to the PUPP
program over a 6-month period.
RESULTS: A 67% reduction in the incidence of nosocomial pressure ulcers is
attributable to the PUPP strategy over a 6-month period for MVH residents. The
average 6-month cost for a MVH Medicare resident is $1928 and $1130 for the
control group and PUPP group respectively. Mean difference (net cost savings per
resident at risk of pressure ulceration) is $798 per resident for PUPP.
CONCLUSIONS: PUPP assisted in reducing the incidence of PrUs by 67% in a 6-month
period in nursing home facilities. The estimated annual net cost savings
attributed to PUPP for 300 MVH residents is estimated at approximately $240,000.
DOI: 10.1097/01.ASW.0000421461.21773.32
PMID: 22990343 [Indexed for MEDLINE]
