The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients

Wenger, Neil S.; Solomon, David H.; Roth, Carol P.; MacLean, Catherine H.; Saliba, Debra; Kamberg, Caren; Rubenstein, Laurence Z.; Young, Roy T.; Sloss, Elizabeth M.; Louie, Rachel; Adams, John; Chang, John T.; Venus, Patricia J.; Schnelle, John F.; Shekelle, Paul G

doi:10.7326/0003-4819-139-9-200311040-00008

Cited by 357 publications

(345 citation statements)

References 24 publications

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“…We compared baseline demographic, clinical, and utilization factors of intervention subjects and controls using t tests, 2 , and Fisher's exact tests. We then calculated crude utilization rates of outcomes following the index date (events per 100 person-years) among intervention subjects and controls and compared rates among the 2 groups by calculating crude incidence rate ratios (IRR) and 95% confidence intervals (CI).…”

Section: Data Analysesmentioning

confidence: 99%

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Fenton

Levine

Mahoney

et al. 2006

The Journal of the American Board of Family Medicine

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Background: Frail elders often receive low-quality primary care, yet the optimal role of geriatricians in primary care settings remains uncertain. We evaluated the health utilization impacts of an innovative intervention emphasizing chronic disease self-management and physical activity promotion among frail elders in primary care.Methods: The intervention was implemented within two primary care practices at a single clinic serving a large population of frail elders enrolled in a western Washington health plan. Subjects included older patients (age >65 years) with disproportionate baseline outpatient service use who attended two on-site visits with a geriatrician during which each received comprehensive assessment and a problemsolving intervention to enhance chronic disease self-management and promote physical activity (N ‫؍‬ 146). Our evaluation had a retrospective matched cohort design. Controls receiving primary care at other health plan clinics were matched 3:1 to intervention subjects by sex and a propensity score (N ‫؍‬ 437), which was computed using demographic, clinical, and health care utilization factors that were predictive of attending the intervention. Among intervention subjects and controls following the intervention, we compared relative rates of hospitalization, outpatient and specialty visits, nursing home admission, mortality, and prescription of selected high-risk medications, as well as total health care costs.Results: From March 2002 to November 2003, the geriatrician evaluated 146 of 725 elderly subjects (20%) in the two primary care practices. During a mean follow-up of 1.3 years, intervention subjects had a reduced rate of hospitalization relative to matched controls (incidence rate ratio 0.57; 95% CI: 0.37 to 0.86; P < .01). Intervention and control subjects did not have significantly different rates of specialty visits, outpatient visits, nursing home admission, mortality, or high-risk prescriptions. Relative to matched controls during follow-up, total health care costs were 26.3% lower among intervention subjects (95% CI: 1.3%, 44.9%; P ‫؍‬ .04).Conclusions: Outpatient geriatric interventions emphasizing collaboration between geriatricians and primary care physicians, chronic disease self-management, and physical activity may reduce hospitalization risk and total health care costs among vulnerable elders. (J Am Board Fam Med 2006;19: 331-9.)

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Section: Data Analysesmentioning

confidence: 99%

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Fenton

Levine

Mahoney

et al. 2006

The Journal of the American Board of Family Medicine

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“…Only 55% of quality indicators were met. 5 However, they also found that the care for geriatric conditions such as falls, urinary incontinence, and dementia was much worse than for general conditions such as atrial fibrillation and stroke. For geriatric conditions, only 31% of recommended care was provided, again with high variability in quality of care; for example, 82% of recommended stroke care was delivered, but only 9% of end-of-life quality indicators were met.…”

Section: Introductionmentioning

confidence: 99%

Systems Approaches to Improve Quality, Performance, and Efficiency in the Care of Older Adults

Reuben¹

2007

TPJ

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“…The Assessing Care of Vulnerable Elders (ACOVE) investigators found that vulnerable older persons had substantial deficiencies in care, particularly in areas that require specialized geriatric care techniques. 15 Older patients are particularly vulnerable in the emergency medical system. 5 EDs are major health care providers for seniors; yet, there has been little development of quality measures for this group of patients.…”

mentioning

confidence: 99%

Quality Indicators for Geriatric Emergency Care

Terrell

Hustey²,

Hwang³

et al. 2009

Academic Emergency Medicine

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118

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Objectives: Emergency departments (EDs), similar to other health care environments, are concerned with improving the quality of patient care. Older patients comprise a large, growing, and particularly vulnerable subset of ED users. The project objective was to develop ED-specific quality indicators for older patients to help practitioners identify quality gaps and focus quality improvement efforts.

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The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients

Abstract: Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.

Cited by 357 publications

References 24 publications

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Systems Approaches to Improve Quality, Performance, and Efficiency in the Care of Older Adults

Quality Indicators for Geriatric Emergency Care

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