Abstract: Racial Disparities in the Healing of Pressure Injury Present at Nursing Home Admission (49th Annual Conference (May 19-23, 2017))

Sunday, May 21, 2017: 9:20 AM

Donna Z. Bliss, PhD, RN, FAAN, FGSA¹, Olga V. Gurvich, MA¹, Kay Savik, MS¹, Lynn E. Eberly, PhD², Susan Harms, PhD, RPh¹, Christine Mueller, PhD, RN, FAAN, FGSA¹, Kristen Cunanan, PhD² and Kjerstie R. Wiltzen, BA, BSN, RN¹, (1)School of Nursing, University of Minnesota, Minneapolis, MN, (2)Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN

Background: There are racial/ethnic disparities in the prevalence and incidence of pressure injury (PrI) in nursing home (NH) residents, but little is known about disparities in PrI healing.

Purpose: To assess racial/ethnic disparities in the healing of PrI present at NH admission.

Methods: Datasets: Minimum Data Set (MDS) (residents’ characteristics, PrI presence/stage) and Online Survey, Certification, and Reporting (NH characteristics/staffing/care deficiencies) from 2000-2002, and 2000 US Census (socioeconomic status of communities around NHs). In a cohort design, MDS records of NH admissions 65+ years with any stage 2-4 PrI (n=10,862) were searched to the 90-day assessment+2 weeks for the first record without any PrI reported, defining PrI healing.

Disparity was assessed with the Peters-Belson method. Potential predictors of PrI healing were first modeled for Whites using logistic regression. Coefficients from the Whites’ model were applied to each minority group in separate models enabling estimation of the percentage of minorities expected to heal PrI, had they been in the Whites’ group, which were then compared to the percentage observed to heal PrI using z-tests.

Results: Admissions with PrI (63% female, aged (82(7.8)) years (mean(SD)), 80% White, 15% Black, 2% Asian, 2% Hispanic) were in 439 NHs in 27 states. PrI healed in 44% of residents overall. Disparity was found for Blacks: A significantly smaller percentage of Black admissions (37%) had PrI heal than expected had they been part of the White group (40%). Odds of PrI healing were significantly lower if PrI was more severe, i.e., Stage 3 (0.3 (0.25-0.36) (OR (95% CI)) or Stage 4 (0.3 (0.25-0.36)) versus Stage 2, or if the NH admission had greater deficits in activities of daily living (0.97 (0.96-0.99)).

Conclusions: Knowledge of disparities in PrI healing can direct interventions to ensure equity in NH care which WOC nurses can facilitate and provide leadership.