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Hospital report cards for hospital-acquired bedsores: How good are the grades?

Medicare’s data source for reporting rates of pressure ulcers acquired during hospital stays not an accurate tool for comparing hospital quality

ANN ARBOR, Mich. —   The data Medicare uses to publicly report hospital rates of patients developing pressure ulcers (or bedsores) is not an accurate source for comparing hospitals on how well they prevent the condition, says a new University of Michigan study.

Bedsores are skin wounds often caused by pressure against the skin when staying in one position for too long. They are among many common hospital-acquired conditions Medicare’s Hospital Compare website reports in an effort to help consumers compare the quality of their care at different hospitals.

Hospital bedsore rates varied widely based on how the data was collected, unfairly making some hospitals appear to fare better or worse than others, according to the findings that appear in the Annals of Internal Medicine.

“We found drastic differences in performance for bedsore rates depending on which type of data was reviewed – hospitals could be graded as either superior or below average depending on the type of data used,” says lead author Jennifer Meddings, M.D., M.Sc., an assistant professor in the Department of Internal Medicine, Division of General Medicine at the U-M Medical School and member of the U-M Institute for Healthcare Policy and Innovation.

“This raises significant concerns about how accurately hospitals are being compared to each other, as this information is reported to the public and may lead to financial penalties for hospitals that seem to be doing poorly.”

 

Dr. Jennifer Meddings
Dr. Jennifer Meddings

Overall, bedsore rates were about 10 times lower when they were based on billing data compared to rates calculated from bedside exams by nurses. In bedside exams, trained teams of independent nurses record rates by periodically evaluating patients for bedsores through a comprehensive skin exam. In contrast, hospital-acquired pressure ulcer cases are identified by hospital coders generating billing data based on how physicians and wound care teams describe wounds in their medical record notes.

“Our findings provide a strong case for removing hospital rates for pressure ulcers from the Medicare’s Hospital Compare website in order to prevent comparisons that may be misleading to patients and policymakers,” says Meddings.
 
Additional Authors: Heidi Reichert, M.A., of the U-M School of Public Health; Tim Hofer, M.D., M.S.c and Laurence McMahon, Jr., M.D., M.P.H. McMahon is the chief of the division of general medicine and professor in the Department of Internal Medicine and Department of Health Management and Policy.

Funding: Agency for Healthcare Research and Quality.

Reference: Ann Intern Med, “Hospital Report Cards for Hospital-Acquired Pressure Ulcers: How Good are the Grades?” Oct.15, 2013; Volume 159, No.8 

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