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Industry: Email Alert RSS FeedReport on the prevalence of skin ulcers in a home health agency population
Advances in Wound Care, Nov/Dec 1999 by Meehan, Marge, O'Hara, Lucy, Morrison, Yolanda M
Abstract
OBJECTIVE: This survey was conducted to assess the presence of skin ulcers within a home health agency population in the United States.
DESIGN: This voluntary survey was conducted by 177 home health agencies. A single observation of each patient within the agency's active caseload formed the cohort examined. Patients deemed to be at low risk (Braden Scale score >19) were eliminated from further evaluation, while those with skin ulcers were evaluated for wound- and caregiver-related factors. Surveys were conducted between March 1, 1996, and December 31,1997.
SETTING: Home health agencies in 19 states throughout the United States, with no restrictions on the type or acuity of the patients served.
RESULTS: A total of 21,529 patients were surveyed, with a prevalence of pressure ulcers (inclusive of all stages) of 6.8% (n = 1455). Rates for each agency ranged between 0.5% and 35.7%. The total number of ulcers reported was 2526 (average per patient was 1.7), with 36% (n = 919) found on the sacrum and the buttocks.
CONCLUSION: Pressure ulcers were the most frequently reported reason for admission to the agency's caseload. Survey results are similar to rates reported in other segments of the health care industry. However, among the home health care population, the primary caregiver is unlikely to be a health care professional. This survey found that the patient's spouse was the primary caregiver in 30% (n = 437) of the 1450 responses received regarding the relationship of the primary caregiver to the patient.
ADV WOUND CARE 1999;9:459-67
SINCE THE INTRODUCTION OF THE Prospective Payment System in the early 1980s, health care in the United States has experienced a fundamental shift toward wellness management and a move away from illness intervention as the primary focus of care. Management of chronic illnesses, patient and family education, and postacute care are now routinely provided through home health agencies (HHAs). In 1997, the National Association for Home Care estimated that more than 20,000 providers delivered home health care services to 7 million patients, with an annual cost of more than $42 billion.1 That approximation represents an 18-fold increase since 1963 in the home health care segment of the US health care system.
Home health agencies provide services that span a wide variety of acuity, serving individuals requiring skilled nursing support for acute illnesses as well as for those needing assistance with activities of daily living (ADLs). The primary diagnosis most frequently cited (26.6%) for home health care patients in a 1994 National Home and Hospice Care Survey was diseases of the circulatory system. I In 1987, nearly half of the patients receiving home health care services were over age 65. The survey also found that approximately 40% of all home health care recipients had functional limitations in I or more ADLs, suggesting a diminished level of mobility among this population.' Such factors signal increased risk for pressure ulcers, yet little is known about the prevalence or incidence of pressure ulcers in the home environment.
Since 1989, Hill-Rom has coordinated several pressure ulcer prevalence surveys. These surveys have provided a framework for health care facilities to conduct benchmark assessments of their own pressure ulcer prevalence, allowing them to institute improvement programs. This paper reports data from the home health care portion of the prevalence surveys.
Literature Review
A community-based survey of pressure ulcer prevalence and incidence was conducted by Oot-Giromini in 1993.2 This convenience sample of 103 home health care subjects in Broome County, NY, demonstrated a pressure ulcer prevalence rate of 29% (n = 30). The majority (45%, n = 19) of the 42 ulcers found were Stage 11 (1.4 per person). The mean age of those found to have ulcers was 76 years.2
Barczak et al published results of the Fourth National Pressure Ulcer Prevalence Survey in July 1997,3 detailing pressure ulcer prevalence in acute care. Table I summarizes the results of that survey, as well as the results of a prevalence survey conducted by Hill-Rom in long-term-care facilities (unpublished data).
Methodology
Participation in the pressure ulcer prevalence surveys was voluntary. One hundred seventy-seven HHAs in 19 states participated (Northeast, n = 4; West, n = 4; South, n = 8; and Midwest, n = 3). The average number of patients served by HHAs included in this survey was 12 (.63 per branch, with an average of 10 branch offices per HHA. The majority of HHAs in the US report between 101 and 300 visits per week.1
Home health agencies that participated in these convenience sample prevalence surveys received extensive training in conducting and recording the results of their observations using the provided data collection instrument. Sample patients were presented in a narrative form during the in-service training sessions. This tool was used to validate each nurse's comprehension of the discrete fields of the Scantron form. That form, consisting of 2 sides with a total of 24 fields, comprised the data collection instrument for all prevalence surveys reported in Table 2. All active cases admitted no later than the first day of data collection were included in the initial risk assessment for the presence of pressure ulcers. Assessment was completed on the entire caseload of each participating HHA by trained prevalence survey nurses. This took an average of 30 days.
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