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2019 HSR&D/QUERI National Conference Abstract

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1077 — Preventing Community-Acquired Pressure Injuries in Spinal Cord Injury: Health Care Provider Perspectives

Lead/Presenter: Lisa Burkhart,  COIN - Hines
All Authors: Burkhart L (Center of Innovation for Complex Chronic Healthcare, Hines VA), Bixler F (Center of Innovation for Complex Chronic Healthcare, Hines VA), Siddiqui S (Harvard Medical School/VA Boston Fellowship Program, Harvard University)

Objectives:
Describe spinal cord injury (SCI) provider perspectives and provider beliefs of their patients' perspectives of the risks, challenges, actions and resources needed to prevent community-acquired pressure injuries (CAPRIs) to inform the development of a decision support tool to be used in outpatient SCI.

Methods:
Individual interviews with SCI providers at two VA SCI clinics (one additional planned) were conducted using participatory action research qualitative methods to explore patient CAPrI prevention behaviors, challenges in skin management, and willingness to engage in CAPrI prevention for patients at low, medium, and high risk for CAPrIs. Interviews explored provider perspectives and provider beliefs of their patients' perspectives related to CAPrI prevention.

Results:
Healthcare provider participants (n = 19, 11 additional planned) were mostly women (68%), mean age 51 (range 32-65), interprofessional (e.g., physician, registered nurse, social work, psychologist, physical therapist), and provided SCI care for an average of 12 years (range: 2.5-28). Several key themes were identified, including: criteria for defining low, medium, and high risk of acquiring CAPrIs, as well as current preventive behaviors, ideal behaviors and willingness to engage in preventive behaviors in patients with SCI. Providers consistently identified currently recognized risk factors, actions, and resources for acute care (e.g., pressure relief, nutrition, skin assessments), but alignment between provider perspectives and provider beliefs of patient perspectives differed based on patient low, medium, and high risk for CAPrIs. These views aligned for low risk patients and strongly diverged for high risk patients.

Implications:
In general, providers noted that patients at low risk of PrI had adequate education, were willing, and had resources to prevent CAPrIs, but those with high risk lacked supports to address risks or did not recognize risks, actions, and resources needed to prevent CAPrIs. The diversity in criteria for defining low, medium, and high risk for CAPrIs supports the need for a CAPrI risk factor assessment tool.

Impacts:
This research guides the development of a decision support tool to be used in outpatient SCI to identify risk factors, actions and resources to prevent CAPrIs for individuals with SCI.