National Voluntary Consensus Standards for Developing a Framework for Measuring Quality for Prevention and Management of Pressure Ulcers

Purpose

This National Quality Forum (NQF) project seeks to develop a framework for measuring quality for prevention and management of pressure ulcers at both the facility and practitioner levels across the continuum of healthcare.

Background

Pressure ulcers are a complex clinical problem with a variety of causes.  They are an adverse outcome of admission to a healthcare facility and are one of the five most common causes of harm to patients.  In addition, pressure ulcers are key clinical indicators of the standard and effectiveness of care.  Even though they are largely preventable and major technical advances have been made in preventing them, pressure ulcers still occur at unacceptable rates within healthcare facilities.¹

Pressure ulcers are both high- cost and high- volume adverse events.  In 2006, there were 322,946 reported cases of Medicare patients with a pressure ulcer as a secondary diagnosis—each case had an average charge of $40,381 for an annual total cost of $13 billion.²

Quality measurement organizations have worked to reduce the prevalence of pressure ulcers in nursing homes, home health, and nursing-sensitive hospital measurement.  To date, NQF has endorsed six measures addressing pressure ulcers.  The measures use a variety of definitions, specifications, staging, and timeframes such that the results are not comparable among settings of care or for a single patient that moves to different care settings.  To understand the impact of pressure ulcers across populations, quality measures addressing prevention, incidence, and prevalence of pressure ulcers must be harmonized and aligned. This will require collaboration among measure developers and other interested stakeholders.

Scope of Activities

In this project, NQF will perform an environmental scan of performance measures and of evaluation tools pertaining to pressure ulcers in all healthcare settings.  In addition, NQF will seek to develop a framework that addresses 1) preventing and healing  pressure ulcers; 2) measuring the incidence and prevalence of pressure ulcers and the pros and cons of both; 3) performing analysis at multiple levels, including providers, systems, communities, and geographical areas; 4) determining accountability as the patient moves across settings of care, i.e., present on admission, etc.; 5) measuring and staging of pressure ulcers, including temporarily “unstageable” and scoring systems; 6) multiple lesions and deep tissue injury in evolution; and 7) harmonizing measure specifications across settings of care.

The NQF Process

The framework will be considered for NQF endorsement as voluntary consensus standards.  Agreement around the recommendations will be developed through NQF’s formal Consensus Development Process.  This project, like all NQF activities, involves the active participation of representatives from across the spectrum of healthcare stakeholders and is guided by a Steering Committee. 

Funding

Funding for this project has been provided by the Centers for Medicare & Medicaid Services.

For more information, contact Lisa Hines, BSN, MS, at 202-783-1300 or pressureulcer@qualityforum.org.