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inpatient rehabilitation facilities, long-term care hospitals, Medicare, post-acute care, pressure ulcer, risk factors, skilled nursing facilities



  1. Seibert, Julie PhD, MPH
  2. Barch, Daniel PhD
  3. Bernacet, Amarilys MPH
  4. Kandilov, Amy PhD, MA
  5. Frank, Jennifer MPH
  6. Free, Lindsey BS
  7. Roberts, Quantesa MA
  8. Reilly, Karen ScD
  9. McMullen, Tara PhD
  10. Levitt, Alan MD
  11. Mandl, Stella BSN, RN
  12. Smith, Laura PhD


OBJECTIVE: To describe and explore relationships between social demographic factors and incidence or worsening of pressure ulcer scores among post-acute care (PAC) settings.


DESIGN: The authors present the incidence of new or worsening pressure ulcers stratified by self-reported patient race and sex. Investigators used logistic regression modeling to examine relative risk of developing new or worsened pressure ulcers by sociodemographic status and multiple regression modeling to estimate the relative contribution of facility-level factors on rates of new or worsening pressure ulcers.


SETTING: Three PAC settings: long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities.


PARTICIPANTS: Medicare Part A residents and patients with complete stays in PAC facilities during 2015.


MAIN OUTCOME MEASURE: The incidence of new or worsened pressure ulcers as calculated using the specifications of the National Quality Forum-endorsed pressure ulcer quality measure #0678.


MAIN RESULTS: The sample included 1,566,847 resident stays in 14,822 skilled nursing facilities, 478,292 patient stays in 1,132 inpatient rehabilitation facilities, and 121,834 patient stays in 397 long-term care hospitals. Significant differences in new or worsened pressure ulcer incidence rates by sociodemographic factors were found in all three settings. Black race, male sex, and advanced age were significant predictors of new or worsened ulcers, although controlling for health conditions reduced the racial disparity. The authors noted significant differences among facilities based on ownership type, urban/rural location, and sociodemographic makeup of facilities' residents/patients.


CONCLUSIONS: There is evidence of disparities in the incidence of new or worsened pressure ulcers across PAC settings, suggesting publicly available quality data may be used to identify and ameliorate these problems.