Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment

Article Abstract:

A fair quality comparison among long-term care facilities should include ratings adjusted for differing patient risk and care requirements. Quality assessments frequently report the incidence of pressure ulcers among the facility's patients. Researchers identified risk factors associated with pressure ulcers among 31,150 patients in long-term care facilities and developed a model for adjusting the ulcer risk according to these factors. They used this model to predict the risk for pressure ulcers in an additional 17,946 long-term care patients. Adjustments for patient characteristics altered the rankings of the 74 facilities studied. Facilities ranked 8th and 11th moved to 17th and 32nd after adjustment for patient risk factors. Five facilities fit the description of a high-risk facility before risk adjustment but only two facilities fit that description after adjustment. Predictions of pressure ulcer rates closely matched the actual rates. Identified risk factors included need for assistance in walking or other movement.

Statistics, Bedsores, Decubitus ulcer

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Predicting the occurrence of adverse events after coronary artery bypass surgery

Article Abstract:

Elderly patients who are severely ill upon admission to the hospital may have a higher risk of complications or death after coronary artery bypass surgery than those who are less ill. Among 2,213 Medicare patients over 65 years old who underwent coronary bypass surgery, 31% developed one or more non-fatal complications and 7% died within 30 days of admission to the hospital. Patients who had previously undergone bypass surgery or emergency surgery had a higher risk of developing complications than other patients. Individuals with a history of chronic obstructive pulmonary disease or who had suffered a heart attack also had a higher risk of complications than other individuals. Other factors associated with an increased risk of complications included an abnormal chest X-ray, an increased pulse, increased blood levels of urea nitrogen and more advanced age. Patients with coronary artery disease involving one or two blood vessels had a lower risk of developing complications than other patients.

Aged, Elderly, Evaluation, Cardiovascular diseases, Surgery, Coronary artery bypass

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Inadequate management of blood pressure in a hypertensive population

Article Abstract:

Many people with hypertension are not receiving adequate treatment. Researchers evaluated the care received by 800 people with hypertension over a two-year period. About 40% had high blood pressure despite frequent visits to their doctor. Blood pressure dropped in those who received the most intensive treatment but rose in those who received the least intensive treatment. Intensive treatment consisted of increasing the dose of antihypertensive medication or changing to another drug.

Care and treatment, Hypertension

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