Abstract

Pressure injuries represent a major public health problem among older adults in the United States. Over the past decade, numerous policies and payment reforms have focused on reducing the incidence of pressure injuries and improving their quality of care. Pressure injuries typically occur in medically complex patients that receive treatment from multiple different providers over short periods of time, and the quality of care delivered in one setting may impact measured quality, patient outcomes, and cost/utilization in another. Despite the recent national focus on pressure injury quality of care, there is a paucity of national research evaluating patients with this condition across different clinical encounters and settings of care. In this dissertation, we explored three distinct research aims using linked Medicare claims data to study pressure injury coding and population characteristics on a national level. The first aim studied consistency of pressure injury documentation across interfacility transfer encounters. The second aim compared hospital-reported present-on-admission status for pressure injuries to diagnostic history in claims data, and the third aim used linked claims data to study the overall pressure injury population across different settings of care. Our results demonstrated that pressure injury coding was not consistent across adjacent facility claims highlighting issues of documentation reliability and potential inaccuracy in claims data. We also found a substantial discrepancy between hospital-reported present-on-admission status of pressure injuries and diagnostic patient history in claims data. This finding has important implications for quality measurement and payment reimbursement in the acute inpatient setting, because current quality measures for pressure injuries rely on hospital-reported POA data to evaluate provider performance. Finally, we identified baseline differences in patient demographics, clinical comorbidity, and risk-adjusted mortality among patients diagnosed with pressure injuries in different settings of care that may inform future research, policy, and payment reform. Taken together these results provide an important overview of the strengths and limitations of linking Medicare claims data to study patients with pressure injuries. The findings of this work may inform future research and quality measure development for pressure injuries and other chronic conditions.