Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

Abstract

BackgroundCare of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients.ObjectivesThe purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions.MethodsWe systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI.ResultsSeventeen studies were included with 278 QIs (original, adapted or newly developed). The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR): 11%–35%), depression (IQR: 27%–41%), osteoporosis (IQR: 34%–43%) and osteoarthritis (IQR: 29–41%) were notably low. Medication management and use (range: 81%–90%), hearing loss (77%–79%) and continuity of care (76%–80%) scored higher than other conditions. Out of the 278 QIs, 141 (50%) had mean pass rates below 50% and 121 QIs (44%) had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%.ConclusionsQuality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

The dynamics of quality: a national panel study of evidence-based standards

“…Our findings are broadly consistent with the findings of a systematic review by Askari et al 13 of 17 papers reporting on achievement of the ACOVE quality indicators, which showed large variation between conditions, and notably low rates for osteoarthritis quality indicators. This review only found a few conditions with a stable pass rate range over multiple studies, and noted that caution is required in making direct comparisons of quality indicator achievement between studies.…”

“…ELSA gathered information on achievement of quality indicators for IHD, hypertension and cerebrovascular disease (CVD) (stroke). A systematic review of 17 quality-of-care papers reporting on the RAND Corporation's Assessing Care of Vulnerable Elders (ACOVE) quality indicators 13 revealed that achievement rates are often high in primary care settings for indicated care for hypertension (72%) and stroke (69%).…”

“…A recent meta-analysis 13 of studies using quality indicators developed for the ACOVE project found low achievement of quality indicators for depression in both primary care settings (31%) and in nursing homes (16%). Duhoux et al 26 assessed adherence rates to 27 quality indicators for depression in 915 adults who consulted a GP, regardless of the reason for the consultation, who also met established criteria for a major depressive episode.…”

“…A meta-analysis of 17 studies using ACOVE quality indicators found that achievement rates for quality indicators for osteoarthritis had an interquartile range of 29-41%. 13 A recent review of chronic disease management found similarly poor quality of care for osteoarthritis across the quality domains of effectiveness, efficiency, safety, timeliness and appropriateness and patient-centred care, despite the availability of several evidence-based clinical practice guidelines. 23 A longitudinal study following 268 patients newly referred to an orthopaedic specialist in the UK over 12 months found that information was provided regarding their condition, pain management and exercise on 42%, 35% and 43% of occasions, respectively.…”

Drug prescribing patterns in elderly patients in a tertiary level hospital

“…10,11 The goal of the American geriatric society revised Beers criteria-2012 was to improve care of elderly patients by reducing their exposure to Potentially inappropriate medications. 12 Early detection of a potentially inappropriate medication can prevent adverse effects. 13 However not all physicians take them into consideration while prescribing to the elderly.…”