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Editorial
Addressing the multisectoral impact of pressure injuries in the USA, UK and abroad
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  1. William V Padula1,2,
  2. Peter J Pronovost2,3
  1. 1 Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
  3. 3 Department of Anesthesiology and Critical Care and Department of Surgery, School of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr William V Padula, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA; wpadula{at}jhu.edu

https://doi.org/10.1136/bmjqs-2017-007021

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    Pressure injuries are problematic to health systems throughout the world, significantly harming over 7 million patients and adding extraordinary costs. The USA, for instance, experiences more than 2.5 million pressure injury cases per year which cause over 60 000 deaths—that is more than car accident fatalities in the USA—and cost the health system at least $9–$11 billion.1 The UK is no less affected by 700 000 cases per year that result in 27 000 deaths and cost the National Health Service (NHS) an estimated £1.4–£2.1 billion.2

    Despite there being no reason to expect major differences in the presentation of pressure injuries between the two countries, the UK appears mainly to have a problem with chronic pressure ulcers, whereas the USA appears to have an increasing burden of acute pressure ulcers.3 4 The UK NHS reports chronic wounds accounting for 78% of the NHS spending on wound treatments.5 On the other hand, the acute issue in the USA may be connected to the Centers for Medicare and Medicaid Services (CMS) reimbursement policy, which has cut payments since 2008 for hospitalised patients who acquired pressure injuries as well as penalised facilities with poorest hospital-acquired condition rates.6 7 This CMS policy also focuses financial responsibility of the pressure injury on the facility that identifies the wound, which means that facilities trying to correct other’s mistakes are often blamed.

    Like most quality measures derived from billing data that have a financial penalty, variability in pressure injury rates is a combination of changes in reporting and how clinicians care for patients by implementing a pressure injury prevention protocol. While we do not have empirical evidence for the relative proportions that these two domains contribute to pressure injury rates, our experience suggests that health systems’ initial response to CMS policy has been improvements in coding and tracking pressure injuries. …

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