Measuring Incidence and Prevalence of PU/PI

Hello everyone and thank you for taking part in the didactic part session presenting the recommendations to a didactic approaches for the Module 3 Prevalence and incidence of PUs/Is of the EPUAP PU Curriculum.
I would like to warmly welcome professor Andrea Pokorná, currently the president of EPUAP, who will guide you through the didactic part of the module 3 of the EPUAP PU Curriculum.
My name id Beata Gress Halasz, I am currently the co- chair of the EPUAP Education Committee, and I will moderate this session.
In this presentation, interviewing Andrea, we will discuss different didactic approaches to help and assist educators to choose suitable tools in their planned lessons of PUs/Is epidemiology. We will also talk about the possible issues, that may occur, and how to prevent, or deal with them.

BGH:
Andrea, how can we suitably approach learners to understand the epidemiological parameters related to PUs/Is?
AP:
I recommend, as the authors of the learning part did, too, to present the theoretical bases in the form of definitions of the basic terms: epidemiology, prevalence, incidence and mortality. It is important to explain the meaning and the purpose of these terms in general as well as in relation to PUs/Is. The basic procedures in epidemiology data collection -> description -> analysis of PUs/Is, the difference between prevalence and incidence, specifically point prevalence, period prevalence, cumulative incidence, incidence density, and the facility-acquired PU/I needs to be explained.

BGH:
The epidemiology data are considered as quality indicators in many countries, or they are used to reflect on the success of care provided and at the same time pointing out the need for change in processes. Therefore, epidemiological data on PUs/Is are an important parameter in healthcare management. How can the educators teach learners to obtain such data?
AP:
Learners need to understand and learn the basics of data calculations. I recommend explaining formulas used, and also to give a few (1-3) examples on how to calculate each parameter. Then it is important to provide learners with handouts containing formulas to calculate incidence and prevalence parameters, so that learners can use them directly, and also keep them even after the session. An electronic calculator can be a very helpful tool. If educators are using internet learning platforms, it can be a good way to simplify and speed up the learning. I suggest having an interactive session/workshop to train the calculation of data on examples as it is recommended in our learning presentation. Let the learners to work individually, in pairs or in a mall group and present their work.

BGH:
The calculations depend on numbers of the chosen condition occurrence. PUs/Is are listed in the IDC-11 list. To source the basic data, we need to know how and where to find and gather these numbers.
AP:
Yes, the IDC-11 is the latest classification of diagnoses. The current coding of pressure ulceration/injury is EH90 indicated as „Pressure ulceration“, where from EH90.0 to EH90.5 are all possible grades listed. EH90.Z is the Pressure ulcer of unspecified grade. To be precise and successful in precise diagnostics, it is important to use the PU/I classification. Form the didactic point of view I recommend providing learners with handouts and/or an access to the relevant web of the IDC-11 and the PUs/Is´ classification tool. What and how to collect data is covered in the learning session of this module. Additionally, educators can if necessary conduct a workshop on differentiation in PUs/Is grades as well as with other skin defects.

BGH:
Epidemiological data on PUs/Is are used across healthcare to assess, measure, and improve the quality of care delivered to patients. These indicators can be used to monitor the influence of improvement initiatives. Therefore, it is important to have the most precise data to know, “where we are at”. To conduct a prevalence and incidence survey or research, what is the best approach to teach this?
AP:
The educators offer examples in a form of research papers that are followingly analysed and discusses, as it is recommended in the learning part of this module. This is a good way for learners to understand and learn the process and methodological steps in conducting such research. This practical way they can learn how to process their own research. However, it is important to decide, if they plan to do a local, national or international research as the design and methodology differ. This module contains rather local and national research examples, as this is relevant for the given level of the EPUAP PU curriculum and the aim of the module. The suggested papers can be however expanded by other papers for self-study.

BGH:
In such data collection and processing, are there any possible issues that need to be prevented?
AP:
The main issues and challenges in conduction such research or surveys are different and inconsistent data sources, methodology approaches, and types of collected data. There is also the question of validity, reliability and objectivity of the research itself, that has to be reviewed. Comparison of results among organizations provides an indication of performance on a local, national or international level, and indicates how an organization benchmarks and performs against others. Therefore, it is highly recommended to highlight such differences in offered papers, so that in comparing incomparable data can be avoided by learners in their future surveys or research. It is also important to discuss with learners, that larger databases (national, international) are less granular or detailed and depend more heavily on medical record documentation than bedside observation. The method developed or selected should strive for the best balance of reliability, validity, responsivity.

BGH:
Surveys and research on incidence and prevalence of PUs/Is contain loads of data, tables and graphs. The interpretation of data, especially for beginners, be a challenge to read and understand them. Graphs can be also easily misunderstood and therefore further misinterpreted. How should educators approach this in their teaching processes?
AP:
The data are usually in a text format organized in a table or a graph. Each of them should be precisely described and data explained. It is a good practice to explain the learners the tables and graphs on concrete examples. Followingly, a workshop can be conducted where learners learn how to interpret data I tables and graphs. In graphs, it is important to explain the x and y line and what they represent. Tables can offer descriptive data (e.g. point prevalence, crosstabs on PUs/Is period prevalence in each age category), and the results of the inductive statistics whether we are talking about the correlations or differences among tested variables (e.g. significant correlation between PU/I stage and patients´ age, significant differences in PU/I cumulative incidence between men and women, etc.). First however, to understand the specific data, a cooperation with an expert in statistics, or a prereading for basic statistic is recommended.

BGH:
The epidemiological data on PUs/Is is collected for different reasons depending on the requirements, settings, or actual emerging situations. It can be the requirement by legal bodies in a form of a Quality Indicator with its specific methodology, or it can be a monthly report, point prevalence report, or any of the possibilities that were presented in the learning part. The main goal however is to improve prevention and care, and patients’ quality of life in general based on the hard data.
AP:
Sure, this is the main aim of each epidemiology data. We want to see, where we are standing, and form that point we can assess deeper, whether the care provided as sufficient, correct, satisfactory, insufficient, or unacceptable. This can be assessed comparing relevant data between wards, facilities, providers, or with previously conducted research/surveys. This is how we than can conclude, if we are positively progressing, or not. This is the approach the educator needs to address to the learners. Comparing different data is a wrong way and the final conclusions then are wrong. Therefore, point prevalence must be compared only with point prevalence, etc. Regular and consistent data collection and evaluation is recommended. Data can be collected over the set period. If the data collection is done more times, it creates a graph where a progress or worsening can be concluded.
Once we have the final actual, objective and reliable results, we can modify the care provided. Further search for gaps is a must to successfully improve the quality of provided care to our patients. For practice change, PDS/CA or Donabedian’s quality improvement framework can be used as a tool.

BGH:
In conclusion of this session focusing on the didactic part of the prevalence and incidence of PUs/Is measurement we recommend:
• Use the reccomended curriculum to create your educational framework.
• Use appropriate educational methods and tools.
• Use keynotes and take-home- messages.
• Incorporate your local and national requirements, standard procedures, legal rules
• Point out the risky areas according to your local/national standards and procedures.
• Approach learners the context of multidicsiplinarity.
• Focus on prevention as a priority.

Thank you for your attendance.