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The discussion considers the findings and implications in the context of rural or urban location. This article reports on the study methods, noting results that demonstrated differences across all characteristics. Contextual factors that influence PURs and FRs can be conceptualized at three levels: community, hospital, and nursing unit characteristics. Using the broadest definition: context is “everything that is not the intervention” ( Ovretveit et al., 2011, pg. It is generally understood that contextual factors are important to consider when examining HACs, but challenges remain about how context is defined and how it affects HACs. No change was noted for FRs, with 260,000 patients falling every year ( AHRQ, 2015).Īlthough multicomponent care interventions to prevent pressure ulcers and falls are well-established, evidence about which contextual factors influence PURs and FRs is mixed or lacking ( Shekelle et al., 2013). While PURs decreased by 23% from 2010 to 2014, more than 1 million patients still developed a pressure ulcer in 2014. Improvement to decrease pressure ulcer rates (PURs) and fall rates (FRs) is especially important because these are among the most common, preventable, and costly HACs ( ASHRM, 2015). However, in 2014 the rate of HACs was 1 discharges, clearly demonstrating that more work is required. Improvement to decrease pressure ulcer rates and fall rates is especially important because these are among the most common, preventable, and costly HACs. As a result of the increased focus on HACs, the Agency for Healthcare Research and Quality (AHRQ) reported a decline of 17% in HACs from 2010 to 2014 ( AHRQ, December 2015). The goal of HENs was to identify solutions to reduce HACs and disseminate them to other hospitals and healthcare providers ( 2015b). Another initiative is CMS funding in 2011 of 26 Hospital Engagement Networks (HENs) with approximately 3,700 hospitals. This policy started in 2008 as part of the CMS long-standing Value-Based purchasing initiative and was later authorized by Congress under the Affordable Care Act (ACA CMS 2015a). One example is the Centers for Medicaid and Medicare Services (CMS) non-payment policy whereby hospitals no longer receive payment for certain HACs. Since the Institute of Medicine (IOM) estimated in 1999 the number of preventable hospital acquired conditions (HACs IOM, 2000), several national quality improvement initiatives have been implemented. Keywords: rural/urban location, pressure ulcers, falls, staffing, practice environment, nurse outcomes, NDNQI® Many areas identified may be useful to implement multilevel improvement strategies tailored specifically to a rural or urban hospital.Ĭitation: Baernholdt, M., Hinton, I.D., Yan, G., Xin, W., Cramer, E., Dunton, N., (March 15, 2017) "A National Comparison of Rural/Urban Pressure Ulcer and Fall Rates" OJIN: The Online Journal of Issues in Nursing Vol.
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Using the National Database of Nursing Quality Indicators (NDNQI®) this study examined differences in care processes and community, hospital, and nursing unit characteristics that influence PURs and FRs in 4238 rural and urban nursing units. Contextual factors and care processes may impact HACs. Despite recent decline in hospital acquired conditions (HACs), rates for pressure ulcers (PURs) and falls (FRs) remain at levels that require improvement.