Using the case mix of pressure ulcer healing to evaluate nursing home performance

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Age Factors; Female; Humans; Male; Middle Aged; Nursing Homes; Paralysis; Pressure Ulcer; *Quality Indicators, Health Care; Severity of Illness Index; Sex Factors; Terminally Ill; *Wound Healing


Biostatistics | Epidemiology | Health Services Research


Pressure ulcer healing is an important quality measure for nursing homes, but the factors that predict healing have not been well studied. Using the Minimum Data Set, the authors identified candidate variables for a logistic regression, risk-adjustment model to predict ulcer healing. The authors then assessed model discrimination and calibration. Finally, the authors compared unadjusted with risk-adjusted performance for the individual facilities within a nursing home chain. Significant predictors of healing included mobility in bed, presence of a stage 2 ulcer (compared with a stage 4 ulcer), absence of paraplegia and quadriplegia, and absence of end-stage illness. The model C statistic was 0.67, and the calibration was acceptable. Judgments about nursing performance varied in 2 cases depending upon whether unadjusted or risk-adjusted performance was used. The model that the authors developed contains credible predictors of healing. Pressure ulcer healing may be one of many indicators used to evaluate nursing home quality.

DOI of Published Version



Am J Med Qual. 2008 Sep-Oct;23(5):342-9. Epub 2008 Jun 25. Link to article on publisher's site

Journal/Book/Conference Title

American journal of medical quality : the official journal of the American College of Medical Quality

PubMed ID


Related Resources

Link to Article in PubMed