Collagen powder dressing in the treatment of pressure ulcer. Multicenter comparative study assessing effectiveness and cost

Pressure ulcers are lesions that usually occur to people to whom the social and economical repercusions are quite serious. Although present treatments with moisture cure dressings are efficient and have a lot of advantages than traditional cure, they do not solve the problem in a significant group of patients, whose ulcers do not heal or need a much longer treatment. Collagen dressings represent an important improvement, since collagen is a key element for wound scarring.     

家庭护理成本核算的方法及其意义

为了促进我国家庭护理成本研究体系的发展,为相关政策的制定提供依据,分析界定了家庭护理成本核算的相关概念,探讨了成本核算的意义及国内外家庭护理成本核算的方法。     

Pressure ulcer prevention and management: the current evidence for care

Pressure ulcers, a common occurrence across healthcare settings, are a costly phenomenon. Since the publication of the AHCPR Guidelines on Pressure Ulcer Prevention and Treatment in the 1990s, additional attention has been focused on pressure ulcer prevention and management. This article discusses current evidence regarding known causes of pressure ulcers, pressure ucler prevention, pressure ulcer classification and assessment, and interventions to effectively manage pressure ulcers.     

The quality of pressure ulcer prediction and prevention in home health care.

The purpose of this study was to assess the quality of pressure ulcer prediction and prevention in home health care. Randomly selected Medicare-certified home care agencies in four midwestern states were surveyed. The overall response rate was 44% (n = 128). Approximately half (57.8%) of the responding agencies assessed all patients for pressure ulcer risk upon admission; another 4.7% assessed only chair or bed-bound patients. Clinical nursing judgment was the most commonly (72%) used method for assessing risk; only 21% of the agencies used a validated tool such as the Braden Scale or the Norton Scale to identify those at risk. Approximately one third of the reporting agencies had prediction and/or prevention policies. Only 18.0% of home health care agencies identified recommended interventions in a pressure ulcer prevention protocol. Findings suggest opportunities for improvement in pressure ulcer prediction and prevention practice in home health care.     

The cost and efficacy of home care for patients with chronic lung disease

A randomized controlled trial was conducted to assess efficacy and cost of sustained home nursing care for patients with chronic lung disease. Three hundred one patients were randomly assigned to a respiratory home care group (RHC) that received care from respiratory home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were followed for 1 year. At the end of the study year, there was no difference in survival, pulmonary function, or everyday functioning among the three groups. Average annual cost of care for all study patients was $7,647 (1981-82 dollars). The average annual health care costs for patients in the RHC group was $9,768; for those in the SHC group, $8,058; and for those in the OC group, $5,051 (F = 6.45, df = 2/298, P = 0.02). These results suggest that the current policy of limited coverage of home nursing services by Medicare and other third-party payers may be appropriate.     

The influence of a change in medicare reimbursement on the effectiveness of stage III or greater decubitus ulcer home health nursing care

This study was designed to describe and evaluate the influence of a change in a Medicare reimbursement on the effectiveness of home health nursing care for stage III or greater decubitus ulcer patients. This health policy originated from the Balanced Budget Act (BBA) of 1997 and took its full effect with initiation of the Prospective Payment System (PPS) on October 1, 2000. A quantitative quasi-experimental design used OASIS data from the state of Virginia to evaluate 555 stage III or greater decubitus ulcer patients, age 65 or older. Comparisons were investigated between pre-PPS, 2000, and post-PPS, 2001, outcomes related to reported ulcer healing, lengths of stay, and discharge disposition. Results demonstrated significant differences for the outcomes studied. In addition, sanitation, ulcer healing, and discharge disposition were linked as predictors for length of stay. Results demonstrated that PPS has affected nursing care effectiveness for stage III or greater decubitus ulcer home health patients.     

Sharps injuries in the home health care setting: risks for home health care workers.

Home health care nurses are at risk of needlesticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting. This article describes a cross sectional prevalence pilot study of needlesticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area. Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies. The exposures were categorized using an existing categorization system and compiled into a composite report. A total of 52 exposures occurred; nurses sustained 92% of exposures. Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 13.5% during or after blood draw. Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting.     

乌鲁木齐市高血压患者社区健康管理成本效果分析

目的：通过对高血压患者的社区健康管理,确定高血压社区健康管理模式的投入与产出,改变高血压患者的知信行,提出降低乌鲁木齐市高血压病患者降压治疗费用的合理建议。方法随机整群抽取乌鲁木齐市两所社区18岁以上患高血压病常住居民809例进行连续1年的社区健康管理,按随机数字表法随机将南湖二附院社区分为观察组,第二济困医院社区分为对照组,其中观察组414例,对照组395例;研究两组患者知识行为改变、治疗费用等情况,分析高血压健康管理成本效益。结果两组患者高血压知识及行为改变情况比较,观察组血压分级、超重肥胖知识知晓率分别为17．94％,43．10％,高于对照组（3．04％,29．77％）,差异有统计学意义（χ2值分别为-5．688,15．608;P＜0．01）;观察组正常血压范围、危险因素知晓情况优于观察组,差异有统计学意义（ Z值分别为-11．927,-17．677;P ＜0.01）。两组患者治疗费用比较,观察组全部患者药物治疗费用、住院患者平均住院费用分别为（1583．88±981．24）,（10725．77±11688．26）元,均少于对照组,差异有统计学意义（ t值分别为2．14,2.75;P＜0．05）;观察组服药患者药物治疗费用、其他费用均低于对照组,差异均有统计学意义（P＜0.01）。结论高血压社区健康管理能取得较好成本效益,是降低高血压病成本、提高高血压病患者生命质量的重要举措。     

Putting the pieces together: private-duty home healthcare and geriatric care management: one home health agency's model

This article examines how one home health agency successfully launched a geriatric care management program. The methods of market assessment, the necessary staff to implement the program, and an overview of geriatric care management in general are presented together with an actual case study.     

Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers

Background. In the Netherlands much attention has been paid to pressure ulcer prevention. National guidelines on pressure ulcer prevention were developed in 1985 and adapted in 1992 at the request of a national organization for quality assurance in health care. Several studies indicate that nurses seem to be insufficiently informed about pressure ulcer preventive activities. There is, however, no information available about the reasons why nurses seem to be insufficiently informed. Aims and objectives. This study was planned to elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention. Design. A qualitative study with semi‐structured, tape‐recorded interviews. Method. Interviews were conducted with enrolled nurses, team leaders, head nurses, staff nurses and physicians. The interviews were coded and analysed. Results. Analysis of the interviews revealed that today's pressure ulcer preventive activities are very much based on old traditions in nursing. It also showed that enrolled nurses have no intention to change the care they deliver with regard to pressure ulcer prevention. Conclusions. It is concluded that a systematic approach is necessary to change nursing thinking and acting with regard to pressure ulcer prevention. Relevance to clinical practice. This study gives an overview of the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention. These views and beliefs can be used as a starting point for effective implementation of guidelines regarding the prevention of pressure ulcers.     

Nurse and client perceptions of home health wound care effectiveness after a change in Medicare reimbursement

The purpose of this study was to begin to explore client and nurse perceptions related to how a change in a Medicare reimbursement, Prospective Payment System (PPS), affects home health care. The target population included home health clients with stage III or greater decubitus ulcers, age 65 years or older. Six Virginia home health agencies were randomly selected. From those sites, all 39 charts that met population criteria were accessed and analyzed, and then 16 care recipients were purposely selected. In addition, 26 home health nurses with pre- and post-PPS experience were purposefully selected. Semistructured, audiotaped interviews were conducted, transcribed, and analyzed using thematic content analysis. Results demonstrated PPS adaptive behavior and an increase in use of education and family caregivers related to wound care. Themes that emerged included professional competence, caregiver as key, and sense of support. Perceptions emphasize the necessity for resource management, collaboration, and patient advocacy.     

Pressure ulcer care in Spain: nurses' knowledge and clinical practice

AIM: This paper is a report of a study to determine: (a) Spanish nurses' level of knowledge of existing guidelines for pressure ulcer prevention and treatment, (b) the level of implementation of this knowledge in clinical practice and (c) the professional and educational factors that influence knowledge and practice. BACKGROUND: Improvement in pressure ulcer care depends both on the dissemination of knowledge and on its implementation in clinical practice. Studies carried out in several countries have demonstrated gaps in knowledge about recommendations for pressure ulcer care and deficiencies in their implementation. METHODS: A survey was carried out between September 2001 and June 2002, targeting a cluster randomized sample of 2006 Registered Nurses and Licensed Practice Nurses working at hospitals, primary healthcare centres and elder care centres in Andalusia (Spain). RESULTS: The response rate was 36.9% (n = 740). The level of knowledge of prevention interventions was 79.1%, while that of treatment interventions was 75.9%. The levels of implementation in clinical practice were notably lower: 68.1% for prevention, and 65.3% for treatment. Nurses holding a university degree obtained higher scores, and those who had received specific education in pressure ulcer care obtained higher scores both for knowledge and clinical practice. Taking part in research projects also improved knowledge implementation. CONCLUSION: Although most of the recommendations on pressure ulcer care found in guidelines are well known by nurses, there is a group of interventions about which they have insufficient knowledge and low implementation rates.