Pressure Ulcer Framework 

Project Status: Completed

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

Access the Final Report: National Voluntary Consensus Standards for Developing a Framework for Measuring Quality for Prevention and Management of Pressure Ulcers 

The Opportunity

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.  

However, to understand the impact of pressure ulcers across populations, quality measures addressing prevention, incidence, and prevalence of pressure ulcers must be harmonized and aligned. Establishing this framework requires collaboration among measure developers and other interested stakeholders.


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.1 

About the Project

This project was initiated in October 2008.


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.


This NQF project, like all consensus development projects, will be conducted according to NQF's Consensus Development Process (version 1.8). The project will be guided by a steering committee.


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

Contact Information 

For more information, contact Melissa Mariñelarena, RN, BSN, MPA at 202-783-1300 or 


  1. Association of periOperative Registered Nurses, Skin Integrity.  Available at

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