Research Finds Pressure Ulcers Underreported In U.S. Nursing Homes: An article published on August 4, 2022 in the journal Medical Care entitled “Accuracy of Pressure Ulcer Events in US Nursing Home Ratings” concluded: “Pressure ulcers were substantially underreported in data used by NHC [CMS’ Nursing Home Compare] to measure patient safety. Alternative approaches are needed to improve surveillance of health care quality in nursing homes … Nursing homes substantially underreported pressure ulcers between 2011 and 2017, making CMS patient safety measures based on these data highly inaccurate. We assessed reporting by focusing on patients who were hospitalized with a primary diagnosis of pressure ulcer and resided in the same nursing home before and after hospitalization. Of these, 22.4% of pressure ulcers were not reported by nursing homes. When we relaxed our requirements to hospitalizations with a secondary diagnosis of pressure ulcer, 45.0% of pressure ulcers were not reported by nursing homes.”
The study found: “Among long-stay residents, about 74.7% of primary pressure ulcers were reported at all, with 70.2% reported within 1 stage of the hospital diagnosis; 52.1% of secondary pressure ulcers were reported at all, with 46.1% reported within a stage of the hospital diagnosis. Most of the reporting difference between primary and secondary pressure ulcers is explained by differences in the distributions of pressure ulcer severity between the 2 groups; primary pressure ulcer diagnoses were more severe (90.6% in stages 3 and 4) than secondary diagnoses (42.2% in stages 3 and 4) and reporting substantially increased with higher stage.”
“Among short-stay residents with stage 2–4 pressure ulcers, about 82.2% of primary pressure ulcers were reported at all, with 76.6% reported within 1 stage of the hospital diagnosis; 64.6% of secondary pressure ulcers were reported at all, with 55.9% reported within 1 stage of the hospital diagnosis. As with long-stay residents, primary pressure ulcers were on average more severe (90.5% vs. 39.8% at stages 3–4) and reporting improved with severity. For short-stay residents, we found 42,467 SNF claims at stage 2–4. In 7.3% of these cases, the same facility recorded a pressure ulcer on its Medicare claim but did not report the pressure ulcer to CMS for NHC’s patient safety ratings.”
“Among long-stay residents, differences between White and Black residents were similar in nursing homes with 10% and 70% Black residents. Reporting improved similarly for both races with pressure ulcer severity. Reporting differences between the 2 races were not statistically significant at stage 2, but residents who are Black had significantly higher reporting rates at stages 3 and 4 by about 2.5 (P=0.042) and 2.9 (P<0.001) percentage points, respectively. Results were similar for short-stay residents … Black and Hispanic residents were much more likely to have stage 4 pressure ulcers than White residents, which is consistent with past literature.”
“[W]e found poor correlation between our claims-based measure and NHC ratings and measures. Though the overall 5-star ratings are based on much more than pressure ulcers, including staffing and inspections, the lack of correlation still indicates that a high star rating did not inform the risk of developing a pressure ulcer in a nursing home that was subsequently diagnosed by a hospital. The other correlations compare our claims-based measure with NHC measures that are even more closely related to pressure ulcers, and these too indicate that one’s risk of developing serious pressure ulcers in a nursing home could not be gleaned from publicly reported ratings.”
If you or a loved one suffered injuries (or worse) from pressure ulcer while a resident of a nursing home in the United States due to nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly contact a local nursing home claim attorney in your state who may investigate your nursing home claim for you and file a nursing home claim on your behalf or on behalf of your loved one, if appropriate.
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