Case-mix adjusted incidence of pressure ulcers in acute medical and surgical wards.

Pressure ulcers cause considerable pain and suffering and are also a very expensive drain on NHS funding. Measuring prevalence is particularly useful for guiding use of resources whereas incidence is an outcome indicator of quality of care. Patients and illnesses vary and it may be misleading to make assumptions based on crude incidence figures. A system of case-mix adjustment has been developed in Glasgow (GPSISS). This study used GPSISS to measure case-mix adjusted incidence of pressure ulcers in over 15,000 acute hospital patients. The incidence of pressure ulcers ranged from 1.1% to 2.7%. These low rates, and the time cost and effort involved in ensuring quality data, suggests that significant differences in quality of care may be demonstrated more quickly using processes rather than outcomes and may more directly identify where changes in practice are required.