Nursing Homes Found to be Underreporting Pressure Ulcers

Findings indicates an ‘urgent need’ for an alternative approach to measuring patient safety in nursing homes, researchers say.

A significant percentage of pressure ulcers are not reported by nursing homes says a recent study published by Medical Care, an industry journal, which assessed the accuracy of nursing homes self-reporting situations where residents have pressure ulcers.

For hospital admissions claims with pressure ulcers as the primary diagnosis, 22.4% of them weren't reported by the nursing homes. For those claims with pressure ulcers as the secondary diagnosis, 45% of them weren't reported by the nursing homes.

The Centers for Medicare and Medicaid Services (CMS) allow nursing homes to self-report the data it contributes to the Minimum Data Set (MDS). However, academic and government studies have reported inconsistencies between these reports and medical records

The discussion portion of the study notes that pressure ulcers were substantially underreported by nursing homes from 2011 to 2017, which makes the safety measures CMS developed based on that data inaccurate.[CD1] 

Pressure ulcers were chosen for this study because they're ultimately preventable and can be managed "with vigilant care."

"Our strategy was to assess whether pressure ulcers identified as present-on-admission (POA) in Medicare hospitalization claims for nursing home residents were reported by nursing homes on assessments used by CMA to create patient safety measures," the study stated.

Combining different data sets, using statistical modeling, and considering the strength of their findings next to alternative specifications, the team examined the accuracy of the self-reported data. They also considered whether the severity of the pressure ulcers and or race of the resident played a role in the self-reported data which, along with initial findings, would determine how informative CMS public ratings are in indicating pressure ulcer risk in a nursing facility.

The research team identified more than  110,000 hospital admission claims with pressure ulcers as the primary diagnosis, more than  290,000 claims with it as the secondary diagnosis, and slightly more than 60,000 skilled nursing facility (SNF) claims with it as the primary diagnosis.

The severity of the pressure ulcers varied from white residents to non-white residents. The study found that the percentage of stage four pressure ulcers was "substantially lower" in white residents compared to Black and Hispanic residents.

"This is the first national assessment of the accuracy of nursing home-reported data on pressure ulcers to CMS,” the study stated, “and coupled with previous findings on underreporting falls, indicates an urgent need for an alternative approach to measuring patient safety in nursing homes."