Risk Adjustment for Hospital Characteristics Reduces Unexplained Hospital Variation in Pressure Injury Risk.
Daniel T Linnen, Patricia Kipnis, June Rondinelli and 3 others
PMID 29870519WHAT IT FOUND
Adding a hospital's mortality rate and diabetes share to a pressure injury risk model cut unexplained variation in hospital pressure injury rates by 35%.
Higher mortality was linked to lower risk; diabetes share did not show a clear effect.
Key findings
01Adding hospital mortality and percent of patients with diabetes history to a patient-level pressure injury model reduced unexplained hospital variation by 35% (hospital-level variation 0.59 vs 0.39).
02For each 0.1% increase in a hospital's mean mortality, the hazard for pressure injury decreased by 4.8%.
03For each 1% increase in the hospital proportion of patients with a history of Type 2 diabetes, the hazard increased by 5%, but the result did not reach significance (P = .072).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study cannot prove cause and effect; it found associations. Only 35 hospitals were available for hospital-level comparison, which limits how many hospital variables can show significance. The hospitals were in a large integrated California system and were similar on many measures, so results may not transfer to other settings. Pressure injury cases were taken from the sentinel event database and not independently verified; nurses may have over-documented concern, which could make estimates conservative. The hospital diabetes variable did not reach significance, so it should not be treated as a proven predictor.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the 35% reduction as proof that hospital mortality or diabetes history caused fewer pressure injuries. The study is observational, only 35 hospitals were compared, and the diabetes effect did not reach significance.