Hospital-acquired pressure ulcers are 10 times more common than Medicare data shows, research suggests

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The Medicare program often paints a far rosier picture of hospitals' pressure ulcer rates than is indicated by data collected bedside by nurses, according to a newly published study.

The underlying challenges identified by the University of Michigan researchers — of identifying and coding pressure ulcers — are familiar to long-term care providers. Hospitals' administrative data is based on billing data generated by hospital coders, who interpret medical record notes left by physicians and wound care teams. Medicare considers this type of data to determine how many pressure ulcers occur at a hospital, which is posted on the Hospital Compare website and used in calculating financial penalties.

The researchers compared this administrative data with “surveillance data,” which was derived from the results of bedside skin assessments given by nurses. The team looked at 2 million all-payer administrative records from about 450 California hospitals and quarterly surveillance data from 213 hospitals in the state.

Overall, the surveillance data resulted in pressure ulcer rates that were about 10 times higher than the rates based on administrative data, the researchers discovered.

"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," said lead author Jennifer Meddings, M.D., M.Sc., an assistant professor in the Department of Internal Medicine.

The findings indicate the need for a more standardized approach to identifying and accounting for pressure ulcers, according to an editorial that accompanied the study, which was published Tuesday in the Annals of Internal Medicine. The editorial was written by Barbara Pieper, Ph.D., RN, from Wayne State University, and Robert S. Kirsner, M.D., Ph.D., from the University of Miami Miller School of Medicine.

“All providers need to learn pressure ulcer assessment and terminology and correctly record this information no matter how many other diagnoses a patient has," Pieper and Kirsner wrote.