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Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness Comparative Effectiveness Review Number 87

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Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness Comparative Effectiveness Review Number 87 Comparative Effectiveness Review Number 87 Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness Comparative Effectiveness Review Number 87 Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10057-I Prepared by: Oregon Evidence-based Practice Center Oregon Health and Science University Portland, OR Investigators: Roger Chou, M.D. Tracy Dana, M.L.S. Christina Bougatsos, M.P.H. Ian Blazina, M.P.H. Amy Starmer, M.D., M.P.H. Katie Reitel, M.S.W., M.P.H. David Buckley, M.D., M.P.H. AHRQ Publication No. 12(13)-EHC148-EF May 2013 This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Chou R, Dana T, Bougatsos C, Blazina I, Starmer A, Reitel K, Buckley D. Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness. Comparative Effectiveness Review No. 87. (Prepared by Oregon Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 12(13)-EHC148-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Christine Chang, M.D., M.P.H. Director Task Order Officer Evidence-based Practice Program Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments We thank our colleagues at the Oregon Evidence-based Practice Center, Leah Williams, B.S., and Elaine Graham, M.L.S., for editorial support and Teresa Goodell, Ph.D., R.N., C.N.S., C.C.R.N., A.P.R.N., B.C., for providing clinical expertise. We appreciate and acknowledge the contributions of the AHRQ Task Order Officer/Medical Officer Christine Chang, M.D., M.P.H. We also thank the Key Informants, members of the Technical Expert Panel, and Peer Reviewers. Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who participated in developing this report follows: Mona Baumgarten, Ph.D., M.Sc. Associate Professor, Department of Epidemiology and Preventive Medicine University of Maryland School of Medicine Baltimore, MD Barbara Braden, Ph.D., R.N. Creighton University, University College Deans Office Omaha, NE Tom Denberg, M.D., Ph.D. American College of Physicians Vice President, Quality and Patient Safety Atrius Health and Harvard Vanguard Medical Associates Cambridge, MA Mary Forceia, M.D., M.P.H. Clinical Associate Professor of Medicine University of Pennsylvania Philadelphia, PA Bonnie Hilburn Senior National Service Officer Paralyzed Veterans of America Kansas City, MO iv Courtney H. Lyder, N.D., G.N.P., FAAN Professor, Internal Medicine and Geriatrics Dean and Professor, School of Nursing University of California–Los Angeles Los Angeles, CA Lana McKenzie Associate Executive Director of Medical Services and Health Policy Paralyzed Veterans of America Washington, DC Susan Miller Centers for Medicare & Medicaid Services Timonium, MD Zena Moore, Ph.D., M.Sc., P.G. Dip., FFNMRCSI Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland Dublin, Ireland Jennifer Murphy, M.D. Assistant Professor in the Department of Surgery Oregon Health & Science University Portland, OR Jyme Schafer, M.D., M.P.H. Centers for Medicare & Medicaid Services Timonium, MD JoAnne D. Whitney, R.N., Ph.D. Professor and Associate Dean for Research, University of Washington School of Nursing University of Washington Seattle, WA Technical Expert Panel The EPC also consulted several technical and content experts regarding the study questions and methodology during the early stages of the report. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing this report follows: v Dan Berlowitz, M.D., M.P.H. Professor of Health Policy and Management Boston University Director of the Center for Health Quality, Outcomes and Economic Research Bedford VA Medical Center Bedford, MA Joyce Black, R.N., Ph.D. Associate Professor, College of Nursing University of Nebraska Medical Center Omaha, NE Tom Denberg, M.D., Ph.D. American College of Physicians Vice President, Quality and Patient Safety Atrius Health and Harvard Vanguard Medical Associates Cambridge, MA Courtney H. Lyder, N.D., G.N.P., FAAN Professor,
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