Abstract
Aims
The population-based incidence of pressure ulcers shows large differences between the 16 federal states in Germany. The present study analyses the association between state-specific pressure ulcer incidence and selected structural variables.
Subjects and methods
Based on the Diagnosis Related Groups used for diagnosis-specific hospital billing, the population-based incidence of pressure ulcers as primary and secondary diagnosis was calculated for each German state. Data were also stratified for grade (all pressure ulcers vs. grades 3 and 4 only). Ten variables derived from data collected by the German Federal Statistical Office were used to describe of state-specific healthcare structures.
Results
Significant correlations were seen between the state-specific incidence of pressure ulcers as primary and secondary diagnosis per 100,000 and the number of full-time employees in nursing homes per 100,000 (p < 0.1; correlation factor of –0.43 and –0.44, respectively), the number of patients per doctor in hospitals (p < 0.05; correlation factor 0.5 and 0.6, respectively) and for the state-specific incidence of pressure ulcers as primary diagnosis and the number of deaths per 100,000 (p < 0.05; correlation factor of 0.7).
Conclusion
Differences in the population-based incidence of pressure ulcers between the 16 German states seem to be influenced by structural differences in patient care. Further examination of these associations could lead to important political approaches for the reduction of pressure ulcers in Germany.
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Reference
Anders J, Heinemann A, Leffmann C, Leutenegger M, Pröfener F, von Renteln-Kruse W (2010) Dekubitalgeschwüre: Pathophysiologie und Primärprävention. Dtsch Ärztebl Int 107:371–382
Dassen Th (2004) Dekubitusprävalenz. Zeitschr Wundheil 9:174–175
Defloor T, Schoonhoven L, Fletcher J et al (2005) Statement of the European Pressure Ulcer Advisory Panel: pressure ulcer classification—differentiation between pressure ulcers and moisture lesions. J Wound Ostomy Continence Nurs 32:302–306
Halfens RJ, Bours GJ, Van Ast W (2001) Relevance of the diagnosis 'stage 1 pressure ulcer': an empirical study of the clinical course of stage 1 ulcers in acute care and long-term care hospital populations. J Clin Nurs 10:748–757
Johansson B, Fogelberg-Dahm M, Wadensten B (2010) Evidence-based practice: the importance of education and leadership. J Nurs Manag 18:70–77
Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ (2007) Nurse staffing and quality of patient care. Evid Rep Technol Assess (Full Rep) 151:1–115
Kosiak M (1959) Etiology and pathology of ischämic ulcers. Arch Phys Med 40:62–69
Kröger K, Niebel W, Maier I, Stausberg J, Gerber V, Schwarzkopf A (2009) Prevalence of pressure ulcers in hospitalized patients in Germany in 2005: data from the Federal Statistical Office. Gerontology 55:281–287
Meesterberends E, Halfens RJG, Heinze C et al (2011) Pressure ulcer incidence in Dutch and German nursing homes: design of a prospective multicenter cohort study. BMC Nurs 10:8–14
Nolte E, McKee M (2004) Changing health inequalities in east and west Germany since unification. Soc Sci Med 58:119–136
Püschel K, Heinemann A, Seibel O, Lockemann U, Matschke J, Seifert D,Tsokos M (1999) Epidemiologie des Decubitus im Umfeld der Sterbephase: Analyse im Rahmen der Leichenschau. Jahreserhebung 1998, Selbstverlag, Hamburg, Germany
Samuriwo R (2010) Effects of education and experience on nurses’ value of ulcer prevention. Br J Nurs 19:S8–18
Schöllgen I, Huxhold O, Tesch-Römer C (2010) Socioeconomic status and health in the second half of life: findings from the German Ageing Survey. Eur J Ageing 7:17–28
Scott JR, Gibran NS, Engrav LH, Mack CD, Rivara FP (2006) Incidence and characteristics of hospitalized patients with pressure ulcers: State of Washington, 1982 to 2000. Plast Reconst Surg 117:630–634
Stausberg J (2007) Quality of coding in acute inpatient care. Bundesgesundheitsbl Gesundheitsforsch Gesundheitssch 50:1039–1046
Strand T, Lindgren M (2010) Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: a descriptive cross-sectional study. Intensive Crit Care Nurs 26:335–342
Unruh L (2003) Licensed nurse staffing and adverse events in hospitals. Med Care 41:142–52
Weber B, Castrup HJ (2010) Lack of due diligence in the prophylaxis of pressure ulcers? EWMA J 10:29–34
Wilborn D, Grittner U, Dassen T, Kottner J (2010) The National Expert Standard Pressure Ulcer Prevention in Nursing and pressure ulcer prevalence in German health care facilities: a multilevel analysis. J Clin Nurs 19:3364–3371
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Kröger, K., Becker, R., Weiland, D. et al. Regional differences in the incidence of inpatients with pressure ulcers in Germany. J Public Health 22, 227–233 (2014). https://doi.org/10.1007/s10389-012-0504-0
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DOI: https://doi.org/10.1007/s10389-012-0504-0