Incidence and prevalence data: can we ensure greater accuracy?

Bethell, Elaine

doi:10.12968/jowc.2002.11.8.26429

Cited by 18 publications

(9 citation statements)

References 17 publications

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“…Nonetheless, prevalence studies are commonly undertaken, and probably their greatest value rests in focussing the attention towards pressure ulcers. In addition, they allow for the assessment of prevention practices and adherence to standards and guidelines (Bethell 2002).…”

Section: Discussionmentioning

confidence: 99%

Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland

Moore

Cowman

2011

Journal of Clinical Nursing

120

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Section: Discussionmentioning

confidence: 99%

Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland

Moore

Cowman

2011

Journal of Clinical Nursing

120

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“…The literature review did not identify additional factors about wound descriptions or assessment that might have been omitted by the participants. However, separate studies of documentation (Hon & Jones, 1996; Sterling, 1996; Bethell, 2002), showed that, when left without the framework of a WAF, nurses do not record anything on some potentially clinically significant features. An explanation is that nurses do not work with a variety of wounds everyday, unlike tissue viability specialists, and might need cues.…”

Section: Discussionmentioning

confidence: 99%

Problems identified in gaining non‐expert consensus for a hypothetical Wound Assessment Form

Maylor¹

2003

Journal of Clinical Nursing

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A post-hoc analysis was carried out of a session on a wound management diploma level module that was intended to promote understanding of the complexity of wound assessment. Postregistration student nurses (n = 16) from both hospital and community settings participated in brainstorming of categories (i.e. verbatim expression) they thought should be included in a hypothetical Wound Assessment Form (WAF). Ranking of suggested categories indicated in terms of 'votes' that the most important was 'date', and the least was 'factors affecting healing'. Some categories were rejected (e.g. exudate). Category definitions and rationale were checked after 3 weeks, and compared with those of lecturers in adult nursing (n = 16) to test whether similar themes emerged amongst other non-experts. Postregistration nurses and lecturers gave similar definitions and rationale for categories. A limitation of the study was that it was opportunistic and methodology for researching consensus issues had not been investigated. Views represent nurses in a wide spread of disciplines and have to date only been compared with expert consensus derived from published literature. Themes to emerge were: the importance of WAFs to record-keeping, different understanding of terminology and the monitoring of progress and use of intuition. It was concluded that the purpose of WAFs needs clarification and research should investigate how change in wounds could take account of differences of personal perception. A new method of charting progress or deterioration is being developed.

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“…A prospective design is considered more appropriate, particularly as consistency in data collection is essential 2. Finally, it is important to report the incidence of PUs within the context of risk status of the population of interest, in tandem with the availability and use of preventative strategies 3.…”

Section: Commentarymentioning

confidence: 99%

US Medicare data show incidence of hospital-acquired pressure ulcers is 4.5%, and they are associated with longer hospital stay and higher risk of death

Moore

2013

Evid Based Nurs

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Commentary on: Lyder CH, Wang Y, Metersky M, et al. Hospital-acquired pressure ulcers: results from the national Medicare patient safety monitoring system study. J Am Geriatr Soc 2012;60:268-8. Implications for practice and research▪ Pressure ulcers (PUs) are common and often occur in older persons and those with multiple comorbidities.▪ Patients with hospital-acquired PUs (HAPUs) have longer hospital stays and higher rates of morbidity and mortality; therefore, prevention and early detection are important priorities for nursing care.▪ Interpretation of epidemiological studies of PUs is difficult due to variances in data collection methods and PU classification employed, making cross comparisons between clinical sites challenging. ContextDevelopment of HAPUs is considered an adverse event. 1 Thus, the incidence of HAPU is commonly used as a quality marker for healthcare facilities. One of the challenges in interpreting data lies in the lack of homogeneity in how figures are collated, for example, variability in sample sizes, data collection and PU grading systems employed. For institutions, the ability to benchmark against others is therefore limited, compounding the challenges in determining success in prevention strategies. It is with this background that the current study was undertaken, the aim of which was to determine PU incidence across the USA. MethodsData were collected, retrospectively, for hospital discharges for a 2-year period ( January 2006 to December 2007. The records of 51 842 Medicare fee-for-services in patient discharges, across the 50 states, were analysed for documented presence of PU on admission ( prevalence) and the development of new PUs during hospital stay (incidence). Demographic data and the presence of comorbidities associated with PU risk were also recorded. Diagnosis of a PU was based on the nurse and physician documentation within the medical record. Inter-rater reliability of data collection was established at 90%, between the data abstractors and the principal investigator, before commencement of the study. Data were analysed using descriptive and bivariate analysis, with the focus to compare the differences in characteristics and outcomes for those who did and did not develop a HAPU. FindingsThe nationwide HAPU incidence was 4.5% (n=2313/ 51 842); however, there was a variance between states (3.2%, SE=1.2%). PU prevalence on admission was 5.8% (n=2999/51 842) and of these 16.7% (n=502/2999) developed a new PU during hospital stay. The majority of PUs occurred in individuals aged 75-85 years, who were non-white and had higher rates of comorbidities (p≤0.05). There was a statistically significant association between the development of a HAPU and inpatient mortality, and mortality within 30 days postdischarge (p≤0.001; OR 2.81, 95% CI 2.44 to 3.23; p≤0.001; OR 1.69, 95% CI 1.67 to 1.77, respectively). Furthermore, those with a HAPU had a statistically significant longer length of stay compared to those without a HAPU (11.6±10.1 days vs 4.9±5.2 days, p<0.001).

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Incidence and prevalence data: can we ensure greater accuracy?

Abstract: Practitioners in the UK will only know if they are meeting targets on pressure ulcer reduction if they provide valid and reliable prevalence and incidence data. But all too often, published data contain inconsistencies and can be misleading.

Cited by 18 publications

References 17 publications

Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland

Pressure ulcer prevalence and prevention practices in care of the older person in the Republic of Ireland

Problems identified in gaining non‐expert consensus for a hypothetical Wound Assessment Form

US Medicare data show incidence of hospital-acquired pressure ulcers is 4.5%, and they are associated with longer hospital stay and higher risk of death

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