Pressure Injury

Identifying Attributes

Care Settings
Hospital Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Eligible Hospital / Critical Access Hospital eCQMs
Type of Quality Indicator
Outcome
IOM Quality Dimension
Safety
Domain
Falls and Major Injuries

Defining Attributes

Definition

The measure assesses the number of inpatient hospitalisations for patients aged 18 and older who suffer the harm of developing a new stage 2, stage 3, stage 4, deep tissue, or unstageable pressure injury.

Numerator

Inpatient hospitalisations for patients with a new deep tissue pressure injury (DTPI) or stage 2, 3, 4, or unstageable pressure injury.

Denominator

Inpatient hospitalisations for patients aged 18 and older.

Exclusions

Inpatient hospitalisations for patients with a DTPI or stage 2, 3, 4 or unstageable pressure injury diagnosis present on admission, i.e., the diagnosis of pressure injury has a Present on Admission indicator = Y yes (Diagnosis was present at time of inpatient admission) or W (clinically undetermined). Inpatient hospitalisations for patients with a DTPI found on exam 72 hours or less after the start of the encounter. Inpatient hospitalisations for patients with a stage 2, 3, 4, or unstageable pressure injury found on exam 24 hours or less after the start of the encounter. Inpatient hospitalisations for patients with diagnosis of a COVID-19 infection during the encounter.

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

None

Collection and Reporting Attributes

Type of Data Collection
Electronic/paper chart records
Data Collection Methods

Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting (IQR) Program

Frequency of Data Collection
Annually
Frequency of Data Collection in Days
365
Reporting Methods

Care Compare

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
No

Source and Reference Attributes

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
Yes
Australian Consortium for Aged Care Endorsed
Yes
Identified by PHARMA-Care Project
No
Upload Date
02 December 2025