Explaining the national differences in pressure ulcer prevalence between the Netherlands and Germany--adjusted for personal risk factors and institutional quality indicators.

Background: Pressure ulcers have a known impact on quality of life as well as on morbidity and mortality of the persons affected. Remarkable differences in pressure ulcer prevalence between the Netherlands and Germany have been found during the last 6 years. This study explores to what extent the individual risk of the population and quality indicators of the institutions can explain the variation in national prevalence.

Methods: Data of a binational multi-centred cross-sectional study in 103 hospitals (n = 21,378 patients) and 129 nursing homes (n = 15,579 residents) were analysed using random effects regression models to calculate the differences in national prevalences within the nursing homes and hospitals, adjusted for personal risk for pressure ulcer and quality indicators.

Results: The prevalence of pressure ulcers among the at-risk group (Bradenscore
Conclusion: A remarkable national variation exists in pressure ulcer prevalence and nursing practice. Neither the populations vulnerability for pressure ulcers nor pressure ulcer management as measured in this study could explain this national variation. Therefore, other risk factors should be taken into consideration. Additionally, it is possible that quality indicators are implemented in differing ways with varying levels of effectiveness. Therefore, further research is needed to examine prospectively and in more detail the reality of care within facilities in both countries.