Methods

Results

Discussion

Conclusions and Implications

References

Abstract

Background: Pressure ulcers pose an important quality-of-care challenge in nursing homes, with serious consequences for residents’ health. We assessed the scalability of the On-Time Pressure Ulcer Prevention (On-Time) intervention strategy, developed by the Agency for Healthcare Research & Quality, in nursing homes nationwide.
Intervention: On-Time uses electronic health record reports to identify changes in resident pressure ulcer risk and facilitate multidisciplinary input into clinical decision making. Objective: To assess the scalability and impact of On-Time on pressure ulcer incidence in nursing homes.
Design: We used quasi-experimental methods, employing a difference-in-differences design, to compare the pre-post trends in pressure ulcer incidence in the treatment and comparison homes. Setting and participants: The study population included long-stay residents at high risk for developing pressure ulcers in 47 nursing homes and matched comparison homes in 17 states.
Measures: Stage 2 to 4 pressure ulcer incidence among long-stay residents who met the criteria for high risk, identified using an algorithm adapted from the Minimum Data Set 3.0 Percent of High-Risk Residents with Pressure Ulcers (Long Stay) measure.
Results: The overall decline in pressure ulcer rates for treatment relative to matched comparison homes was statistically insignificant (P > .05). A subgroup of heterogeneous homes experienced a statistically significant decline of 3.24 percentage points (61.0% relative decrease) in pressure ulcer rates relative to matched comparison homes, but no uniting characteristic common across homes readily explained their success.
Conclusions/Implications: Scalability of future health information technologyebased quality improvement interventions in nursing home settings requires nuanced implementation support, particularly around electronic health record report accessibility and accuracy.

Conclusions and Implications

Despite the lack of an overall effect, the study was able to increase understanding of the scalability and associated challenges of this EHRbased intervention in nursing homes. Specifically, this study shows that nursing home readiness to undertake EHR-dependent quality improvement is a function of staff commitment and preparation, and EHR vendor engagement. In the case of On-Time, the intervention really begins when the reports are accessible to staff to use within the change teams, something that is not easily achieved. Additional research is needed to understand how best to reduce the investment required to prepare (both for the facility and for the EHR vendor) so that the promise of EHR-based interventions to reduce the incidence of adverse effects can be realized.