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Deriving a Risk-Adjustment Model for Pressure Ulcer Development Using the Minimum Data Set

Authors

  • Dan R. Berlowitz MD, MPH,

    1. Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts;
    2. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts;
    3. Boston University Schools of Medicine and Public Health, Boston, Massachusetts; and
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  • Gary H. Brandeis MD,

    1. Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts;
    2. Boston University Schools of Medicine and Public Health, Boston, Massachusetts; and
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  • John N. Morris PhD,

    1. Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, Massachusetts.
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  • Arlene S. Ash PhD,

    1. Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts;
    2. Boston University Schools of Medicine and Public Health, Boston, Massachusetts; and
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  • Jennifer J. Anderson PhD,

    1. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts;
    2. Boston University Schools of Medicine and Public Health, Boston, Massachusetts; and
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  • Boris Kader PhD,

    1. Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts;
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  • Mark A. Moskowitz MD

    1. Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts;
    2. Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts;
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Address correspondence to Dr. Berlowitz at CHQOER, Bedford VA Hospital, 200 Springs Road Bedford, MA 01730.

Abstract

OBJECTIVE: To use the Minimum Data Set (MDS) to derive a risk-adjustment model for pressure ulcer development that may be used in assessing the quality of nursing home care.

DESIGN: Perspective observational study using MDS data from 1997.

SETTING: A large, for-profit, nursing home chain.

PARTICIPANTS: Our unit of analysis was 39,649 observations made on 14,607 nursing home residents who were without a stage 2 or larger pressure ulcer on an index assessment.

MEASUREMENTS: Pressure ulcer status was determined at an outcome assessment approximately 90 days after an index assessment. Potential predictors of pressure ulcer development were examined for bivariate associations, contributing to the development of a multivariate logistic regression model.

RESULTS: A stage 2 or larger pressure ulcer developed in 2.3% of the observations. Seventeen resident characteristics were found to be associated with pressure ulcer development. These included dependence in mobility and transferring, diabetes mellitus, peripheral vascular disease, urinary incontinence, lower body mass index, and end-stage disease. A risk-adjustment model based on these characteristics was well calibrated and able to discriminate among residents with different levels of risk for ulcer development (model c-statistic = 0.73).

CONCLUSION: A clinically credible risk-adjustment model with good performance properties can be developed using the MDS. This model may be useful in profiling nursing homes on their rate of pressure ulcer development.

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