Disparities in the Prevention of Perineal Pressure Injury in Black Nursing Home Residents with Incontinence

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.