This study addresses AHRQ PAR-06-448 to """"""""Translate Research into Practice and Policy"""""""" and NIH initiatives to disseminate and implement research into clinical practice. The purpose of this study is to build the body of evidence on pressure ulcer prediction and prevention in home health care and examine the use of a tool, the computerized decision support system, to translate pressure ulcer prediction and prevention to home health care practice. Elders with pressure ulcers experience a 50% increase in mortality, suffer extreme pain, social isolation and many develop complications such as osteomyelitis or bacteremia that require hospitalization. Overall costs for treatment are $9.1 to $11.6 billion per year. Despite a 3% to 17% incidence of pressure ulcers in elder home patients, studies on pressure ulcer prediction and prevention in home health care are few, risk factors for pressure ulcer development in home health patients are understudied, and pressure ulcer prevention is poorly implemented in home health care. The Translating Research into Evidence-Based Practice Model by AHRQ guides the proposed study.
Specific aims are to test the use of a computerized decision support system (CDSS) to trigger alerts for recommended pressure ulcer prevention based on patient risk factors present in Outcome and Assessment Information Set (OASIS) data, delineate interventions and strategies to prevent pressure ulcers in home health care, and validate risk factors that predict pressure ulcer development from OASIS data. This study will partner with information system experts and home health care agencies who already use information technology for patient care. A mixed methods design will be employed that includes a focus group with wound experts to provide data on successful pressure ulcer prevention interventions and strategies used in home health care. The CDSS will include risk factors for pressure ulcer development identified in preliminary studies with elder home health patients and evidence based pressure ulcer prevention enhanced by focus group results. The reliability of the CDSS to trigger alerts for pressure ulcer prevention based on patient risk factors present in OASIS data will be tested and the frequency, range and pattern of recommended interventions examined. The CDSS will be integrated into the information system of participating home health care agencies, tested in clinical practice by home health staff, and evaluated. OASIS data relevant to pressure ulcer risk will be extracted from the electronic medical records of 5000 elder home patients. Multivariate logistic regression analysis will be used to validate risk factors that predict pressure ulcer development from OASIS data. Findings will provide an actionable tool that translates evidence based pressure ulcer prediction and prevention to routine practice in home health care. Systematic implementation and further testing of the CDSS to improve patient quality of care and outcomes are long term goals of this study. Elders with pressure ulcers suffer extreme pain, experience complications that require hospitalization and are 50% more likely to die. Up to 17% of elders develop a pressure ulcer after admission to home health care but research with home health patients is sparse and prevention is poorly practiced. This study will examine the use of a computerized decision support system to improve the identification of elders who are at pressure ulcer risk and improve the practice of pressure ulcer prevention in home health care. ? ? ?
| Bergquist-Beringer, Sandra; Gajewski, Byron J (2011) Outcome and assessment information set data that predict pressure ulcer development in older adult home health patients. Adv Skin Wound Care 24:404-14 |
| Bergquist-Beringer, Sandra; Daley, Christine Makosky (2011) Adapting pressure ulcer prevention for use in home health care. J Wound Ostomy Continence Nurs 38:145-54 |
