• Guihan M, Goldstein B, Smith BM, Schwartz A and Manheim LM (2003). SCI health care provider attitudes about pressure ulcer management. J Spinal Cord Med 26:129-34. Summary: BACKGROUND/OBJECTIVE: To evaluate the variability in clinical decisions about pressure ulcer management for persons with spinal cord injury (SCI) and expand understanding of the various factors influencing variability. METHODS: Eighty-one SCI physicians and nurses completed a survey on pressure ulcer management. Patient scenarios were used to assess the effect of patient characteristics on provider decisions regarding inpatient treatment of severe pressure ulcers, surgery vs medical management, and amount of healing before discharge. RESULTS: The availability of social support to facilitate bed rest appears to be a more important factor in deciding whether the patient is managed at home vs in the hospital than is the level of injury. Medical condition does not appear to influence surgical vs medical management of severe pressure ulcers. For patients with poor social support, more healing was required before discharge, regardless of their medical condition. Providers were queried about other issues that influence management, including inpatient resource availability, patient preferences, the availability and quality of local home care, and the availability and use of formal care protocols. Respondents were virtually unanimous in their agreement that patients who are compliant with prevention measures can avoid ulcer development. CONCLUSION: Like many health care providers, those who provide care to people with SCI are struggling to provide quality care to improve their patients' lives in the absence of good evidence to guide their treatment decisions. The results of the present study indicate that in situations in which there is no strong empirical evidence, variation in care provided is extensive. Midwest Center for Health Services and Policy Research, Edward Hines, Jr, VA Hospital, Hines, Illinois 60141, USA. guihan@research.hines.med.va.gov