Date of Award

January 2016

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Marjorie Funk

Abstract

Abstract

Purpose: To describe community-dwelling adults admitted to acute care with a present-on-admission (POA) pressure ulcer (PU). Specific aims: 1) Measure 1-year POA-PU prevalence, 2) Determine pre-hospital location of patients with POA-PU, 3) Describe demographics, PU characteristics, risk factors, and post-hospital outcome of community-dwelling adults admitted to hospital with a PU.

Design: Retrospective descriptive study.

Subjects and Setting: The sample included all adults, over age 18, admitted to an 800-bed urban academic medical center in New England over a 1-year period with a POA-PU.

Methods: Subjects were identified from a clinically validated PU registry. Data were extracted electronically from selected standardized electronic health record (EHR) fields.

Results: The prevalence of patients admitted to acute care with a POA-PU was 7.4%. For the majority (76.1%), the pre-hospital location was the community; the remainder came from a healthcare facility (23.9%). The community-dwelling subjects (N=1,022) had a mean age of 72.7 ± 15.4; 52.4% were male, 80.3% white, 30.9% lived alone, 99.2% were insured, and 30.6% college educated. They presented with a mean of 1.46 pressure ulcers, of which 37.5% were full thickness. Over half (51.5%) were discharged to a healthcare facility, 33% to home, and 14% died or received hospice care. The 30-day readmission rate was 15.5%.

Conclusion: Clinically-validated surveillance data show a higher prevalence of POA-PU than reported with administrative data. Electronically-extracted EHR data provides population health evidence of community PU occurrence that may be useful for risk stratification, prevention, and care coordination for integrated health systems.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/22/2017

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