Pressure ulcer development in the VA: Characteristics of nursing homes providing best care

This study identifies structural characteristics of VA nursing homes that a re associated with the best patient outcomes. We evaluated risk adjusted ra tes of pressure ulcer development in VA nursing homes and related these rat es to facility size, staffing patterns, teaching nursing home status, and r ural versus urban locale. Higher rates of pressure ulcer development were s een among urban teaching nursing homes and among nursing homes associated w ith both larger and smaller VA hospitals. Staffing patterns had a complex a ssociation with pressure ulcer development, and smaller nursing home staffs were not clearly associated with higher rates. For multivariate modeling, only hospital size and staffing remained significant independent predictors of pressure ulcer develop ment. These results emphasize that while structu ral characteristics of VA nursing homes can provide insights about care, im proving the quality of care in this setting will require a much greater und erstanding how nursing homes are organized to meet patient needs.