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Value Based Purchasing Part I

Updated: Jul 24, 2023


The Centers for Medicare and Medicaid Services (CMS) established the Hospital Value-Based Purchasing Program as a reimbursement model for acute care hospitals. The program was developed to create better outcomes for patients at lower costs, reduce risks in patient care while creating higher patient satisfaction rates, and developing better care efficiencies. Hospitals are measured against multiple metrics in four major areas: Clinical Outcomes, Person and Community Engagement, Safety, and Efficiency and Cost Reduction.[1]


EZ Way safe patient handling solutions will help you achieve higher ratings on three Patient Safety Indicators (PSI):

• PSI-03 - Pressure Ulcer Rate

• PSI-08 - In-Hospital Fall With Hip Fracture Rate

• PSI-12 - Perioperative Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) Rate


In Part I we will look at PSI-03 – Pressure Ulcer Rate, including prevention aids and solutions for these bedsores.


PSI-03 PRESSURE ULCER RATE

This indicator looks at the diagnosis of Stage III and IV pressure ulcers (bedsores). Pressure ulcers are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. People most at risk of bedsores have medical conditions that limit their ability to change positions or cause them to spend most of their time in a bed or chair. The three primary contributing factors are pressure, friction, and shear. Pressure ulcers can result in additional inpatient costs of up to $21,075 per patient.[2]


Constant pressure on a part of the body can lessen blood flow to the tissues. Without proper blood flow, the tissues are deprived of oxygen and other nutrients leading to tissue damage and possible tissue loss. For immobile patients this pressure tends to happen in areas that aren’t well padded with muscle or fat such as the spine, tailbone, shoulder blades, hips, heels, and elbows.


Friction is caused by skin rubbing against clothing or bedding. This can cause damage to fragile skin, especially when it is moist.


Shear happens when two surfaces move in opposing directions such as when a bed is elevated and the patient slides down the bed. As the body is moved, the skin may stay in place and pull in the opposite direction.[3]


WE CAN HELP

Turning and Repositioning Sheets used in conjunction with EZ Way floor and ceiling lifts- Turning patients at least every two hours is recommended for helping to reduce pressure ulcers.[4] EZ Way turning and repositioning sheets can act as a pressure ulcer prevention aid in that it allows caregivers to safely turn and reposition patients. The sheet can be used in conjunction with, or

as a replacement to, a typical bed sheet.




EZ Way spacer fabric- The spacer fabric used in our turning and repositioning sheets and hourglass slings is a three-layer fabric that releases moisture, allows air flow, and dissipates heat. It provides four-way stretch, naturally ventilating properties that wick moisture away from the skin, and soft, cushioning characteristics to reduce force. It has been shown in studies to be the most effective in reducing peak pressures, and more likely to reduce the risk of pressure ulcer development when left under the patient.[5]



Slide Sheets- The friction-reducing characteristics in EZ Way slide sheets allow caregivers to reposition patients and prevent shearing, acting as a viable solution for bedsores. They also reduce the risk of injury to the caregivers.







Air-Assisted Lateral Transfer Mattresses- The PPS Glide air-assisted mattress will safely and effectively perform lateral transfers while reducing the potential for back injury, and reduce the possibility of shearing. Tissue Interface Pressure (TIP) studies were performed on the PPS Glide reusable mattress with analysis on three critical zones, the scapula, sacrum, and heel. The results showed no significant increases in TIP averages when the mattress was left under the patient.




We will look at PSI-08 – In-Hospital Fall With Hip Fracture Rate in Part II of this blog.

[1] https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/HospitalQualityInits/Hospital-Value-Based-Purchasing- [2] Estimating the additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions”, Agency for Healthcare Research and Quality, November 2017 [3] https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing [4] David Pickham, corresponding author Betsy Ballew, Kristi Ebong, Julie Shinn, Mary E. Lough, and Barbara Mayer, “Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): study protocol for a randomized controlled trial” published online 6 April 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823913/#:~:text=To%20prevent%20pressure%20ulcers%2C%20t he,schedule%20in%20critically%20ill%20patients. [5] Webb J, et al., “The impact of hoist sling fabrics on interface pressure whilst sitting in healthy volunteers and wheelchair users: A comparative study”, Journal of Tissue Viability (2017), https://doi.org/10.1016/j.jtv.2017.12.001

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