Pressure ulcers are a significant problem in long-term health care. Estimates of prevalence in the long-term and extended care environments cluster around 8% and appear stable over the past decade. An estimated 30% of new entrants to homebound care are at risk for developing pressure ulcers. Yet it has been forcefully argued that pressure ulcers are largely preventable regardless of a patient's Braden Risk profile when proper precautionary standards of practice are followed. While reduction to zero may be unrealistic, especially in the near-term as a result of institutional, systemic, and individual factors endemic to the U.S. health care system, nonetheless a reduction from the present rates of incidence in long-term and homebound care is feasible and would yield human and financial savings through diminution of patient sequelae and co-morbidity. Improvement in adherence to standard prevention, treatment, and management practices is a reasonable and worthwhile objective. The Academic Edge, Inc. (AEI) is developing a suite of educational materials and support resources to address prevention and treatment of pressure ulcers. These are to be delivered via web as well as other media. The materials will be interactive, accurate, effective, and extensible. The media and site will address pressure ulcers in terms of both prevention and treatment and will target home health aides (HHA), nurses and other supervisory personnel, and, to a lesser, but no less important extent, patients and their families. In Phase 1, AEI demonstrated the feasibility of the effort by identifying salient HHA beliefs, generating core content and design documents, evaluating those documents through end-user focus groups and subject-matter-expert (SME) reviews, and by producing a video covering a portion of the content and conducting a field trial of that video. Phase 2 will develop two interactive courses, a web portal of pressure ulcer information, and job aids and other performance support tools to increase performance of four key objectives: (1) monitoring for signs of pressure ulcers, (2) taking active steps to identify, monitor, and mitigate risk factors, (3) managing pressure ulcers using current standard practices, and (4) supervising others who interact with those at risk for pressure ulcer formation. These will be developed using a theory-based design and development model and will be evaluated continuously using focus groups and advisory panel reviews. The core content and courses will also be evaluated in two sets of field trials: an initial small scale formative (n=20) validation trial for each course that ensures everything is working correctly in each course and a set of larger summative trials (n=440, home health care personnel; n=120 nursing students) that evaluate the effectiveness of the effort. Pressure ulcers are a significant problem in long-term care. The number of individuals receiving long- term homebound care has increased rapidly in the last decade. Home health aides represent the fastest growing occupation in the U.S., with a projected growth rate of 56% over the 2004-2014 period, adding some 350,000 jobs in that same period. Although most home health aides appear to be willing to take steps to reduce the incidence of pressure ulcers, there presently exists no standardized, friendly, and effective training on pressure ulcers and their prevention for the HHA field. What little training does exist generally targets more advanced practitioners and does so through books and other paper-based media. A readily available, evidence-based, and theory driven set of interactive courses, tools, and resources for individual and small group training, developed in multiple media, should be extremely well-received by home health organizations, can be adapted to be used in broader applications, such as pre-professional nursing training, and will positively affect this important, and mostly preventable, public health concern. ? ? ? ?
