Information and Data Brief: Pressure Injuries Find out why a particular quality standard was created and the data behind it
Quality Standards are: Concise sets of easy-to-understand statements outlining what care should look like for people living with certain conditions. Based on the best available evidence. Accompanied by quality indicators that enable organizations to monitor the quality of their care. Designed for health care providers to help them understand what care they should be offering, and how to measure it. Intended to also help patients, residents, families, and caregivers know what to ask for in their care. 2
What is included in this Brief Wounds are a breakdown in the protective function of the skin and represent a significant burden for patients, their caregivers and families, clinicians, and the Ontario health system. There are several types of wounds. This brief includes data and information on Pressure Injuries. Methodological details, references, acknowledgments and additional information are available at the end of this brief. 3
Why this Quality Standard is needed: People with pressure injuries report lower levels of health-related quality of life, 1 higher rates of depression, 2 and higher rates of pain and discomfort. 3, 4 Pressure injuries are damaged skin and/or underlying soft tissue, usually over a bony prominence or are related to a medical or other device. They occur as a result of intense and/or prolonged pressure and/or shear. 5 Pressure injuries are more likely to occur in people who are older; reside in long-term or critical care settings; are acutely ill; have experienced trauma; or have a spinal cord injury, neurological condition, diabetes, impaired mobility, or nutritional deficiency. 6,7 The data reported here does not capture how a new pressure injury developed or worsened. In particular, we cannot identify whether or not it developed as a result of a temporary visit to a different facility. Also, the data do not speak to how these wounds are cared for due to the lack of information on the actual management of pressure injuries. 4
Pressure Injuries: The Data 5
KEY FINDING Hospitalizations for pressure injuries varied three-fold across regions in Ontario. Hospitalization rates for pressure injuries per 100,000 population, in Ontario, by LHIN region, 2014/15 Rate per 100,000 100 90 80 70 60 55 58 58 60 61 63 71 77 79 84 88 50 40 35 36 41 30 27 20 10 0 Waterloo Wellington Mississauga Halton Central West North Simcoe Muskoka Central East North West Central Ontario Hamilton Niagara Haldimand Brant South West South East Champlain North East Erie St. Clair Toronto Central Local Health Integration Network (LHIN) Region Source: Discharge Abstract Database, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO 6
KEY FINDING Patients hospitalized with a pressure injury transition to a variety of settings, highlighting the importance of collaboration within and across settings. Anticipated discharge destination for patients with a pressure injury, in Ontario, 2014/15 21% 36% Continuing Care Facility Acute Inpatient Facility 7% Home with Support Services Home with no Support Services Other 31% 6% Note: Continuing Care Facility includes Long Term Care Facilities, Complex Continuing Care Facilities and Inpatient Rehabilitation. Source: Discharge Abstract Database, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO 7
KEY FINDING The percentage of Complex Continuing Care patients who had a new or worsened pressure ulcer since their last assessment varied more than three-fold across LHIN regions. Percentage of complex continuing care residents who developed new or worsened pressure ulcers, in Ontario, by LHIN region, 2015/16 Percent 10 8 6 4 2 1.8 1.9 2.3 3 3 3.4 3.4 3.7 3.7 3.9 4.4 4.6 5 5.2 5.9 0 South East Mississauga Halton Toronto Central Erie St. Clair North East Central East North Simcoe Muskoka Ontario Champlain North West South West Local Health Integration Network (LHIN) Region Central West Waterloo Wellington Hamilton Niagara Haldimand Brant Central Note: Results are risk-adjusted. Source: Continuing Care Reporting System, Canadian Institute for Health Information (CIHI) 8
KEY FINDING The percentage of long-term care home residents who had a new or worsened pressure ulcer since their last assessment varied between 2.0% and 3.5% across LHIN regions. Percentage of long-term care home residents who developed new or worsened pressure ulcers, in Ontario, by LHIN region, 2015/16 Percent 10 8 6 4 2 2.0 2.4 2.4 2.5 2.8 2.8 2.9 2.9 3.0 3.1 3.2 3.2 3.3 3.4 3.5 0 Mississauga Halton Toronto Central Central Central West Central East Champlain Ontario South East North Simcoe Muskoka Hamilton Niagara Haldimand Brant Waterloo Wellington North East Erie St Clair South West North West Local Health Integration Network (LHIN) Region Note: Results are risk-adjusted. Source: Continuing Care Reporting System, Canadian Institute for Health Information (CIHI) 9
KEY FINDING The percentage of home care patients who had a new pressure ulcer since their last assessment varied two-fold across Ontario s regions. Percentage of home care patients with a new pressure ulcer, in Ontario, by LHIN region, 2015/16 Percent 10 8 6 4 2 0.9 0.9 0.9 1 1 1 1 1.1 1.1 1.1 1.2 1.2 1.4 1.6 1.9 0 Mississauga Halton Toronto Central Central East Erie St Clair South West North East North West Ontario South East Local Health Integration Network (LHIN) Champlain Waterloo Wellington Central Central West North Simcoe Muskoka Hamilton Niagara Haldimand Brant Note: Results are risk-adjusted. Source: Home Care Reporting System, Canadian Institute for Health Information (CIHI) 10
Methodological notes: Pressure Injuries Indicator Numerator Denominator Source Notes Hospitalization rates for a pressure injury per 100,000 population in Ontario, by LHIN region, 2014/15. Number of people in the denominator who were hospitalized for a pressure injury. Number of people in the population. Discharge Abstract Database, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Includes those with a most responsible diagnosis of a pressure injury (pre-admit). Anticipated discharge destination for patients with a pressure injury in Ontario, 2014/15. Discharge destination upon discharge. Number of people discharged with a primary diagnosis of a pressure injury. Discharge Abstract Database, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Includes those with a most responsible diagnosis of a pressure injury. New or worsening pressure ulcer rates in CCC, in Ontario, by LHIN region, 2014/15. Number of people in the denominator with a new or worsening pressure ulcer. Percentage of complex continuing care patients. CIHI, CCRS. Risk Adjusted. Percentage of long-term care home residents who developed a new or worsened pressure ulcer, in Ontario, by LHIN region, 2015/16. Number of people in the denominator with a new or worsening pressure ulcer. Percentage of long-term care residents. CIHI, Continuing Care Reporting System (CCRS). Risk Adjusted. Percentage of home care patients with a new pressure ulcer, in Ontario, by Local Health Integration Network (LHIN) region, 2015/16. Number of people in the denominator with a new pressure ulcer. Percentage of long stay home care patients. Canadian Institute for Health Information (CIHI), Home Care Reporting System (HCRS). Risk Adjusted. 11
References 1. Thein HH, Gomes T, Krahn MD, Wodchis WP. Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario. Qual Life Res. 2010;19(1):81-9. 2. Galhardo VA, Garroni Magalhaes M, Blanes L, Juliano Y, Masako Ferreira L. Health-related quality of life and depression in older patients with pressure ulcers. Wounds. 2010;22(1):20-6. 3. Essex HN, Clark M, Sims J, Warriner A, Cullum N. Healthrelated quality of life in hospital inpatients with pressure ulceration: assessment using generic health-related quality of life measures. Wound Repair Regen. 2009;17(6):797-805. 4. Gorecki C, Closs SJ, Nixon J, Briggs M. Patient-reported pressure ulcer pain: a mixed-methods systematic review. J Pain Symptom Manage. 2011;42(3):443-59. 5. National Pressure Ulcer Advisory Panel [Internet]. Washington (DC): The Panel; c2016. Press release, National Pressure Ulcer Advisory Panel (NPUAP) announces a change in terminology from pressure ulcer to pressure injury and updates the stages of pressure injury; 2016 Apr 13 [cited 2016 Apr 25]. Available from: http://www.npuap.org/national-pressure-ulcer-advisorypanel-npuap-announces-a-change-in-terminology-frompressure-ulcer-to-pressure-injury-and-updates-the-stagesof-pressure-injury 6. National Institute for Health and Care Excellence. Pressure ulcers: prevention and management. London (UK): The Institute; 2014. 7. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington (DC): National Pressure Ulcer Advisory Panel; 2014. 12
Acknowledgements Health Quality Ontario acknowledges and thanks Mr. Joshua Moralejo, Nursing Practice Leader, Salvation Army Toronto Grace Health Centre, and Ms. Connie Paris, Manager, Home & Continuing Care Data Management, Canadian Institute for Health Information (CIHI) for review of this brief. Portions of this presentation are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of CIHI. Additional Resources This Information Brief is intended to support the quality standard for Pressure Injuries, which can be found in full on the Quality Standards page of the Health Quality Ontario website. 13
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