Abstract: Disparities in the Prevention of Perineal Pressure Injury in Black Nursing Home Residents with Incontinence (49th Annual Conference (May 19-23, 2017))

Donna Z. Bliss, PhD, RN, FAAN, FGSA¹, Olga V. Gurvich, MA¹, Lynn E. Eberly, PhD², Susan Harms, PhD, RPh¹, Christine Mueller, PhD, RN, FAAN, FGSA¹ and Beth Virnig, PhD³, (1)School of Nursing, University of Minnesota, Minneapolis, MN, (2)Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN, (3)School of Public Health, University of Minnesota, Minneapolis, MN

Background: Pressure injury prevalence is higher in Black nursing home (NH) residents than Whites so prevention is critical. Incontinence is a risk factor for perineal pressure injury (PPrI).

Purpose: To assess disparities in preventing PPrI in Black NH residents who developed incontinence after NH admission

Methods: Predictors of PPrI were from Minimum Data Set (MDS) records (residents’ characteristics), >2 million practitioner orders (POs) for treatments/cares of residents, Online Survey, Certification, and Reporting (NH characteristics/staffing/care deficiencies) from 2000-2002, and 2000 US Census (socioeconomic status of communities around NHs). The cohort had 10,424 residents aged 65+ years (in 448 NHs in 27 states) who developed incontinence after admission, were free of PPrI, and were not receiving PrI prevention. In a cohort design, MDS and POs were searched for PPrI prevention from the day of incontinence until PPrI developed or records ended.

Disparity was assessed with the Peters-Belson method: Potential predictors of PPrI prevention were modeled for Whites using logistic regression. Resulting coefficients were applied to minority groups in separate models estimating the % minorities expected to receive PPrI prevention, had they been in the Whites’ group. These percentages were then compared to the percentages observed to receive PPrI prevention using z-tests.

Results: The cohort was 71% female, aged (83(7.6) years (mean(SD)), 89% White and 8% Black. There was a significant disparity in preventing PPrI in Blacks (p<.001). The percentage of Blacks observed to receive PPrI prevention (5.4%) was significantly less than expected had they been part of the White group (3%). Significant predictors (OR, 95% CI) of receiving PPrI prevention were older age (0.98(0.96-0.99)), fewer cognitive deficits (0.87(0.82-0.92)), % NHs in an urban area (1.44(1.05-2.03)) and % residents receiving Medicaid (0.99(0.98-0.99)).

Conclusions: Eliminating disparities in preventing PPrI can improve health of incontinent Black NH residents. WOC nurses can promote equity in care.