COMPARISON OF CLINICAL INDICATORS IN 2 NURSING-HOMES

Objective: Pressure ulcer prevalences in 30 VA nursing homes in 1986 ranged from 0% to 15%. The institutions with lowest (''A'') and highest (''B'') prevalence were selected for further examination. Design: Analysis of nursing home files for five study periods, each lasting 6 months. Setting: A and B were 60-bed rural and 280-bed urban facilities, respectively. Measurements: Eleven outcome indicators were calculated for each study period: prevalences and incidences of pressure ulcer, aggressive behavior and disruptive behavior, 6-month declines in each of the four activities of daily living (ADLs), and prevalence of underweight. Results: Populations in A and B were similar with regard to age, sex, length of stay, degree of dependency, and level of nursing care. All indicators for the first study period were more favorable in A than in B. In addition, underweight (body mass index <22 kg/M2) was significantly less prevalent in A than in B. The differences between the two institutions in the indicators were persistent over the five study periods from 1988 to 1991. Conclusions: The populations of A and B were similar in the available measures of severity of illness. Nevertheless, the residents in nursing home A were significantly less likely to experience adverse outcomes than were the residents in nursing home B. The virtual absence of pressure ulcers, physical aggression, and verbal disruption in nursing home A, despite the presence of many immobile and demented residents, suggested that these complications can mostly be prevented.