Report on the prevalence of skin ulcers in a home health agency population

Abstract

OBJECTIVE: This take a view of was conducted to assess the neighborhood of skin ulcers within a domicile health agency population in the United States.

DESIGN: This voluntary observe was conducted by 177 residence health agencies. A single observation of each patient within the agency's active caseload formed the cohort examined. Patients regarded to be at low risk (Braden Scale score >19) were eliminated from further evaluation, while those with skin boils were evaluated for wound- and caregiver-related factors. observes were conducted between March 1 1996 and December 311997

SETTING: dwelling health agencies in 19 states from one extremity to the other of the United States, with no restrictions upon the type or acuity of the patients serv

RESULTS: A total of 21529 patients were take a view ofed with a prevalence of compressing ulcers (inclusive of all stages) of 68% (n = 1455) Rates for each agency ranged between 05% and 357% The total number of boils reported was 2526 (average through patient was 1.7), with 36% (n = 919) place on the sacrum and the buttocks.

CONCLUSION: squeezing ulcers were the most at short intervals reported reason for admission to the agency's caseload. review results are similar to rates reported in other sections of the health care industry. However, among the residence health care population, the primary caregiver is unlikely to be a health care professional. This review found that the patient's spouse was the primary caregiver in 30% (n = 437) of the 1450 rejoinders received regarding the relationship of the primary caregiver to the patient.

ADV hurt CARE 1999;9:459-67

SINCE THE INTRODUCTION OF THE Prospective Payment a whole in the early 1980s, health care in the United States has experienced a fundamental shift toward wellness management and a propel 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 from one side home health agencies (HHAs). In 1997 the National Association for place of abode Care estimated that more than 20000 providers delivered residence health care services to 7 million patients, with an annual take away from of more than $42 billion.1 That approximation exhibits an 18-fold increase since 1963 in the residence health care segment of the US health care a whole

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 greatest in quantity frequently cited (26.6%) for abode health care patients in a 1994 National residence and Hospice Care Survey was diseases of the circulatory combination of parts to form a whole I In 1987, nearly half of the patients receiving dwelling health care services were above age 65. The survey also lay the foundation of that approximately 40% of all domicile health care recipients had functional limitations in I or more ADLs, suggesting a diminished horizontal of mobility among this population.' of the like kind factors signal increased risk for squeezing ulcers, yet little is known about the prevalence or incidence of compressing ulcers in the home environment.

Since 1989 Hill-Rom has coordinated several squeezing ulcer prevalence surveys. These take a view ofs have provided a framework for health care facilities to guidance benchmark assessments of their possess pressure ulcer prevalence, allowing them to institute improvement programs. This paper reports data from the abode health care portion of the prevalence observes

Literature Review

A community-based scan of pressure ulcer prevalence and incidence was directioned by Oot-Giromini in 1993.2 This convenience sample of 103 domicile health care subjects in Broome shire NY, demonstrated a pressure gathering prevalence rate of 29% (n = 30) The majority (45% n = 19) of the 42 pustules found were Stage 11 (14 by means of person). The mean age of those fix to have ulcers was 76 years.2

Barczak et al published arises of the Fourth National squeezing Ulcer Prevalence Survey in July 19973 detailing crushing ulcer prevalence in acute care. Table I summarizes the ensues of that survey, as well as the springs of a prevalence survey directioned by Hill-Rom in long-term-care facilities (unpublished data).

Methodology

Participation in the squeezing ulcer prevalence surveys was voluntary. individual hundred seventy-seven HHAs in 19 states participated (Northeast, n = 4; West, n = 4; southerly n = 8; and Midwest, n = 3) The average number of patients serv by means of HHAs included in this contemplate was 12 (.63 per branch, with an average of 10 branch offices through HHA. The majority of HHAs in the US report between 101 and 300 visits through week.1

Home health agencies that participated in these convenience sample prevalence observes received extensive training in conducting and recording the rises of their observations using the provided data collection instrument. Sample patients were at handed 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 overlooks 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 nearness of pressure ulcers. Assessment was complet upon the entire caseload of each participating HHA through trained prevalence survey nurses. This took an average of 30 days.