Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes.

Home health agencies, challenged to demonstrate quality while containing costs, are motivated to find best practices for managing patient and wound care. The effects of different wound therapies on frequency of hospitalization and emergent care, two prominent quality measures, have not been studied. A retrospective study was conducted to determine the prevalence of Stage III and Stage IV pressure ulcers in the home health population and to quantify the impact of negative pressure wound therapy in reducing acute care hospitalizations and emergent care in general, and wound infection or deteriorating wound status in particular. Data from 1.94 million OASIS start-of-care assessments in 2003 and 2004 were evaluated to estimate pressure ulcer prevalence and a retrospective matched group analysis compared patients using (n = 60) and not using (n = 2,288) negative pressure wound therapy. In 2003, 6.9% and in 2004, 7% of patients had pressure ulcers at start of care. Of these, 23% were Stage III or Stage IV and 31% were "not healing." In the matched analysis group, it was found that compared to comparison group patients, those receiving negative pressure wound therapy experienced lower rates of hospitalization (35% versus 48%, P less than .05), hospitalization due to wound problems (5% versus 14%, P less than .01), and emergent care for wound problems (0% versus 8%, P = .01). To offset potential limitations in generalizability and increase practical application of these results, further research is needed with a larger, nationally representative sample to compare other quality outcomes as well as the cost of providing negative pressure wound therapy to other specific wound care modalities.