Pressure ulcer prevalence in long-term nursing home residents since the implementation of OBRA '87. Omnibus Budget Reconciliation Act

J Am Geriatr Soc. 2002 Apr;50(4):728-32. doi: 10.1046/j.1532-5415.2002.50169.x.


Objectives: To evaluate change in pressure ulcer prevalence in long-term nursing home residents since the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87).

Design: Cross-sectional comparison of two time periods.

Setting: Ninety-two nursing homes scheduled for a quality-of-care survey randomly selected from 22 representative states.

Participants: Four thousand six hundred seventy-nine residents who had resided in the facility for at least 100 days were evaluated: 2,336 during 1992-1994 and 2,343 during 1997-1998.

Measurements: Trained registered nurses collected data on pressure ulcer prevalence, stage, and risk factors from medical record review during on-site evaluations. Risk-adjusted differences were estimated using logistic regression.

Results: Unadjusted prevalence rates for all stages of pressure ulcers (8.52% vs 8.54%, P =.983) and those rated stage 2 or greater (5.31% vs 5.63%, P =.624) did not differ between the two time periods. After adjustment for urinary incontinence, immobility, poor nutrition, and history of previous pressure ulcers, the relative odds of having a pressure ulcer in 1992/4 versus 1997/8 was 1.06 (95% confidence interval (CI) = 0.84-1.34) for all stages and 1.21 (95% CI = 0.92-1.60) for stages 2 and greater.

Conclusions: No change in pressure ulcer prevalence was demonstrated since implementation of OBRA '87 in this nationally derived sample of long-term nursing home residents.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Centers for Medicare and Medicaid Services, U.S.
  • Cross-Sectional Studies
  • Humans
  • Length of Stay
  • Nursing Homes*
  • Pressure Ulcer / epidemiology*
  • Pressure Ulcer / etiology
  • Prevalence
  • Quality of Health Care
  • Risk Factors
  • Time Factors
  • United States / epidemiology