Underreporting Pressure Injuries

Unreliable Data

Health Leaders warned families not to rely on self-reported data. The U.S. Centers for Medicare and Medicaid Services (CMS) established the Nursing Home Compare website in the 1990s to publicly report patient safety indicators for every nursing facility in the nation.

Nursing homes self-report quality measures or clinical indicators to CMS. This data includes pressure injuries. However, nursing homes do not accurately report the data.

A new study found that about 30% of bedsores suffered by short-term nursing home residents and about 40% of bedsores in long-term residents were not reported to the Nursing Home Compare database. Researchers chose pressure injuries for this study because they’re preventable “with vigilant care.”

Cover-up or Honest Mistake?

The journal Medical Care discovered the industry appears to drastically underreport the number and severity of pressure injuries suffered by residents in nursing homes. The Nursing Home Compare website data is drawn from the Minimum Data Set (MDS). The MDS is an assessment of individual patients that nursing homes must send to CMS every three months.

Underreporting can escalate the issues for these residents, as Jaysmyne Ray presents figures surrounding this issue. Nursing homes failed to report 22.4% of hospital admissions with ulcers as the primary diagnosis.  For those claims with pressure ulcers as the secondary diagnosis, nursing homes failed to report 45% of them. Incredible.

These pressure injuries develop due to neglect. Caregivers fail to move and offload pressure over bony prominences. Pressure injuries develop due to the lack of custodial and nutritional care for residents.

Pattern and Practice?

Underreporting by nursing homes is not new. And it includes other traumatic incident such as falls and injuries of unknown origin. An article by Dennis Thompson at the HealthDay Reporter provides damning statistics surrounding falls in nursing homes. If a nursing home allows a resident to suffer a traumatic fall, policy requires a root cause analysis.

“The 2020 study found that more than 40% of major injury falls that resulted in hospitalization weren’t reported.”

Nursing homes often leave these reports blank. And if reported, oftentimes inaccurate. They fear a lower star rating. As a result, the act of underreporting and misreporting seems to be a common pattern. The self-reported data is not reliable. The study notes that nursing homes  substantially underreported pressure ulcers from 2011 to 2017 which makes the data inaccurate.