Publications : 2013

Meddings J, Reichert H, Hofer T, McMahon L. 2013. Hospital report cards for hospital-acquired pressure ulcers: How good are the grades? Ann Internal Med 159(8):505–513.



Value-based purchasing programs will use administrative data to compare hospitals by rates of hospital-acquired pressure ulcers (HAPUs) for public reporting and financial penalties. Validation of administrative data for these purposes, however, is lacking.


To assess the validity of the administrative data used to generate HAPU rates to compare hospitals for public reporting and financial penalty, by comparing hospital performance as assessed by HAPU rates generated from administrative and surveillance data.


Retrospective analysis of 2 million all-payer administrative records for 448 California hospitals and quarterly hospital-wide surveillance data for 213 hospitals from the California Nursing Outcomes and Prevalence Study (as publicly reported on CalHospitalCompare).


196 acute-care hospitals with >=6 months of available administrative and surveillance data


Non-obstetric adults discharged in 2009.


Hospital-specific HAPU rates were computed as the percentage of discharged adults (from administrative data) or examined adults (from surveillance data) with >=1 HAPU stage II and above (HAPU2+). Categorization of hospital performance using administrative data was compared to the grade assigned using the surveillance data.


By administrative data, the mean (CI) hospital-specific HAPU2+ rate was 0.15% (0.13, 0.17); by surveillance data, the mean (CI) hospital-specific HAPU2+ rate was 2.0% (1.8, 2.2). Of the 49 hospitals with HAPU2+ rates from administrative data in the highest (worst) quartile, the surveillance dataset assigned these hospitals performance grades of “Superior” for 3 hospitals, “Above Average” for 14 hospitals, “Average” for 15 hospitals, and “Below Average” for 17 hospitals.


Data are from 1 state, 1 year.


Hospital performance scores generated from HAPU2+ rates varied considerably from administrative data and surveillance data, suggesting administrative data may not be appropriate for comparing hospitals.