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## Complete Summary

#### TITLE

Pressure ulcers: percentage of patients with clinically significant
complications.

#### SOURCE(S)

American Medical Directors Association. Tool kit for implementation of
the clinical practice guidelines for pressure ulcers \[binder\].
Columbia (MD): American Medical Directors Association (AMDA); 2004.
various p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Outcome

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key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients with pressure
ulcers with clinically significant complications.

#### RATIONALE

In the institutional setting, the prevalence of patients with pressure
ulcers is between 2.5% and 24%, with an average of 1.6 to 2.5 wounds per
patient. The incidence of pressure ulcers in nursing facilities is 0.20
to 0.56/1000 patient-days, which may increase to 14/1000 patient-days
among those at high risk. The aged are most susceptible, with 70% of
pressure ulcers occurring in patients over age 70. The most commonly
affected sites, compromising approximately 80% of wounds, are the pelvic
girdle (including ischium, sacrum, coccyx, and trochanters) and heels. A
patient with a pressure ulcer has a 2 to 6 times greater mortality risk
than one with intact skin.

While pressure ulcers sometimes develop in spite of the best efforts of
nursing staff and other multidisciplinary team members, many of these
ulcers can be healed if detected promptly and treated at an early stage.
Other pressure ulcers are not preventable or may be slow to heal because
of patient factors that cannot be changed.

This is one of American Medical Directors Association\'s (AMDA) twelve
suggested quantitative process or clinical outcomes measures related to
implementation of pressure ulcer clinical practice guidelines (CPGs) in
a long-term care facility. These measures are based on the four
components of the AMDA pressure ulcers management process: Recognition,
Assessment, Treatment, and Monitoring.

#### PRIMARY CLINICAL COMPONENT

Pressure ulcer; complications

#### DENOMINATOR DESCRIPTION

Number of individuals with pressure ulcers

#### NUMERATOR DESCRIPTION

Number with pressure ulcers with clinically significant complications

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Calabrese B. (Director of Research, Clinical Nurse Manager, AMDA
Foundation. Columbia, MD). Personal communication. 2005 Oct 3. 2 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement

### Application of Measure in its Current Use

#### CARE SETTING

Long-term Care Facilities

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Allied Health Personnel\
Dietitians\
Nurses\
Physician Assistants\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Single Health Care Delivery Organizations

#### TARGET POPULATION AGE

Unspecified

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

See \"Rationale\" field.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

See \"Rationale\" field.

#### BURDEN OF ILLNESS

See \"Rationale\" field.

#### UTILIZATION

Unspecified

#### COSTS

-   Pressure ulcers can increase nursing time up to 50%, and are very
    costly in time and resources.

-   Every year, pressure ulcers affect more than one million acute care
    and nursing facility patients. Costs associated with treatment
    exceed one billion dollars annually. Within this total, more than
    355 million dollars is spent on pressure ulcer treatment in
    long-term care settings. Lawsuit claims per occupied bed have
    increased at an annual rate of 14 percent, while the average court
    settlement has risen 250,000 dollars.

#### EVIDENCE FOR COSTS

American Medical Directors Association. Tool kit for implementation of
the clinical practice guidelines for pressure ulcers \[binder\].
Columbia (MD): American Medical Directors Association (AMDA); 2004.
various p.

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Number of individuals in the facility with pressure ulcers

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number of individuals with pressure ulcers

**Exclusions**\
Unspecified

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Institutionalization

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Number with pressure ulcers with clinically significant complications

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Institutionalization

#### DATA SOURCE

Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### OUTCOME TYPE

Adverse Outcome

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a lower score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Percentage of patients with clinically significant complications.

#### MEASURE COLLECTION

[Pressure Ulcer
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1750&doc=7400)

#### MEASURE SET NAME

[Clinical Outcome
Measures](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1750&doc=7404)

#### DEVELOPER

American Medical Directors Association

#### FUNDING SOURCE(S)

There was no funding for the development of the measures. However, Ross
Products Division of Abbott Laboratories did provide funding for the
Pain Management Guideline Implementation Tool Kit.

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Medical Directors, Physicians, Pharmacists, Registered Nurses, Advanced
Practitioners, Nursing Home Administrators, Registered Dieticians, Wound
Care Specialist

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

None

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2004 Sep

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Medical Directors Association. Tool kit for implementation of
the clinical practice guidelines for pressure ulcers \[binder\].
Columbia (MD): American Medical Directors Association (AMDA); 2004.
various p.

#### MEASURE AVAILABILITY

The individual measure, \"Percentage of patients with clinically
significant complications,\" is published in \"Tool Kit for
Implementation of the Clinical Practice Guideline for Pressure Ulcers.\"
This tool kit can be ordered from the [American Medical Directors
Association (AMDA) Web
site](https://www.amda.com/commerce/resourceCatalogOrderForm.cfm).

For more information, contact American Medical Directors Association
(AMDA), 10480 Little Patuxent Parkway, Suite 76, Columbia, MD 21044;
phone: (800) 876-2632 or (410) 740-9743; fax: (410) 740-4572; Web site:
[www.amda.com](http://www.amda.com/).

#### NQMC STATUS

This NQMC summary was completed by ECRI on June 27, 2005.

#### COPYRIGHT STATEMENT

This NQMC summary is based on the original measure, which is subject to
the measure developer\'s copyright restrictions.

### Disclaimer

#### NQMC DISCLAIMER

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008