Article

Documentation of a new or worsened pressure ulcer is a new, required
quality indicator for all inpatient rehabilitation facilities (IRFs) in the
United States; however, there is little research regarding risk factors for
pressure ulcers among patients seen in IRFs.
OBJECTIVE: To examine the risk
factors for development of a new or worsened pressure ulcer among patients seen
in IRFs. DESIGN: A retrospective cohort study. SETTING: IRFs in the United
States. PARTICIPANTS: IRF patients more than 18 years of age, with documented new
or worsened pressure ulcer during their rehabilitation stay (n = 2766) and IRF
patients with no new or worsened pressure ulcer documented from admission to
discharge (n = 190,996) discharged October 2008 to September 2011, included in
the Uniform Data System for Medical Rehabilitation database.
METHODS: Multiple
logistic regression analysis was used to estimate risk factors for the
development of a new or worsened pressure ulcer utilizing data captured in the
Centers for Medicare and Medicaid Services (CMS) payment document. Examined were
demographic variables, including age and gender, medical variables, including
impairment type and presence of comorbidities, and functional status, as measured
through the Functional Independence Measure (FIM) instrument. MAIN OUTCOME
MEASURES: Development of a new or worsened pressure ulcer in patients during the
rehabilitation stay compared to patients with no documented pressure ulcer or no
worsened ulcer. RESULTS: Admission FIM total was strongly associated with
development of a new or worsened pressure ulcer, P <.001 in analyses of all
patients and for each of the 3 impairment-specific groups with the highest rate
of ulcer development among spinal cord injury, orthopedic, and amputation cases.
CMS comorbidity tier was also significantly associated with ulcers in all models.
Other variables that entered one or more models included increased age, male
gender, and use of a wheelchair. CONCLUSIONS: Admission FIM total and CMS
comorbidity tier may be useful in the identification of patients at risk for
development of new or worsened pressure ulcers in IRFs. Identification of
pressure ulcer risk factors has important implications for individual
plan-of-care decisions as well as for resource provisions during the
rehabilitation stay.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved. - USA

Langue : ANGLAIS