Abbreviated Care‐Process Quality Indicator Sets Linked with Survival and Functional Status Benefit in Older Adults Under Ambulatory Care

Abstract

Objectives Better quality-of-care measured by 140 care-process quality indicators (QIs) from the Assessing Care of Vulnerable Elders Study (ACOVE-1) predicts better survival. A subsequent study (ACOVE-2) reduced the measures to 69 ambulatory-care QIs. We identified further need to prioritize and reduce the QIs to facilitate future quality improvement efforts. We aimed to identify subsets of ambulatory QIs associated with better survival and physical function outcomes. Design Observational cohort study Setting and participants 1015 older ambulatory-care patients in ACOVE-1 and ACOVE-2 Measurements To develop the QI subsets, we first convened an expert panel to rate each of 69 ambulatory-care QIs for strength of process-benefit link, defined as: (1) direct trial evidence on older patients, or(2) high expectation of benefit if a trial were conducted in older patients. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE-Quality-for-Survival, AQS-17), 5 QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms(AQQ-16). We first tested whether AQS-17 would predict3-year survival in 1015 pooled ACOVE-1 and ACOVE-2 patients. Second, we tested whether AQF-5(n=74) and AQQ-16(n=359) would predict change in the physical component score (PCS) ofShort-Form-12 at one-year in the ACOVE-2cohort. Controls: age, function-based vulnerability, co-morbidity. Results Each20 percentage-point increment inAQS-17 was associated with survival (HR .83, p=.014)up to 500 days, but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS (1.13-points per 20 percentage-point increment in AQF-5, p=.021). Conclusion Subsets of care processes can be linked with outcomes important to older patients.AQS-17 and AQF-5 are potential tools for improving ambulatory care for older adults.

Older Adults Reporting More Diabetes Mellitus Care Have Greater 9‐Year Survival

“…In contrast, the current results found a relationship with survival, possibly because of the older age of the sample, which would have resulted in greater mortality in general, thereby affording better power for detecting associations. One other study of older adults, the Assessing the Care of Vulnerable Elders study, also reported that composite care process measures (including but not limited to DM care processes) measured using chart review in older U.S. community‐dwelling adults in primary care were associated with short‐term survival and better functional status, independent of age at baseline.…”

Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma

“…18,29,30 Delirium prevention and mobility promotion are two high-priority areas of care for geriatric orthopedic surgery patients. 4,12,31 Therefore, we categorized the QIs into three mutually exclusive subtypes: geriatric condition-based care (e.g., delirium screening) versus non-geriatric care (e.g., thrombosis prophylaxis), delirium care (versus all other care), and care to promote mobility (versus all other care).…”