Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

Arora, Vineet M.; Johnson, Madison; Olson, Jared; Podrazik, Paula M.; Levine, Stacie; DuBeau, Catherine E.; Sachs, Greg A.; Meltzer, David O.

doi:10.1111/j.1532-5415.2007.01444.x

Cited by 83 publications

(102 citation statements)

References 24 publications

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“…52 Preliminary work included testing and validating these measures. 53 Further evaluation of these clinical outcomes and CHAMP's efficacy and durability at the University of Chicago is ongoing and will be presented in future reports.…”

Section: Discussionmentioning

confidence: 97%

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Podrazik

Levine

Smith

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:The University of Chicago Curriculum for the Hospitalized Aging Medical Patient (CHAMP) faculty development program (FDP) is targeted at hospitalists and other internists who teach residents and students in the hospital setting. The aim of CHAMP is to increase the quantity and quality of teaching of geriatric medicine pertinent to the inpatient setting.METHODS:Hospitalist and general internist faculty members who attend on the University of Chicago Medicine teaching service were invited to participate. The CHAMP FDP consisted of twelve 4‐hour sessions. Two hours of each session covered inpatient geriatrics content, and 2 hours addressed improving clinical teaching (both general teaching skills and challenges specific to the inpatient wards) and teaching the Accreditation Council for Graduate Medical Education core competencies with geriatrics content. The evaluation included a self‐report survey of the impact on the graduates' teaching and clinical practice.RESULTS:The FDP was piloted in early 2004 with a core group of geriatrics and hospitalist faculty. Three subsequent cohorts totaling 29 hospitalist and general internal medicine faculty members completed the FDP by the fall of 2006. Faculty participants evaluated the program positively, and significant improvements in knowledge, attitudes to geriatrics, and perceived behavior in teaching and practicing geriatrics skills were found.CONCLUSIONS:The integration of teaching techniques and geriatrics content was enthusiastically accepted by University of Chicago hospitalists and general internists who teach residents and medical students in the inpatient setting. The program has potential for widespread suitability to all teaching faculty who care for the older hospitalized patient. Journal of Hospital Medicine 2008. © 2008 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 97%

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Podrazik

Levine

Smith

et al. 2008

Journal of Hospital Medicine

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“…Amongst 600 participants, 58% were deemed vulnerable. The results showed substantial variation in quality-of-care processes across several domains of care for hospitalized vulnerable elders, with poorer care for conditions found in geriatric patients than for general medicine [49] . This suggests that more in-depth training for medical professionals is needed in the hospital care of older patients, and that there is a need to focus on frailty prevention.…”

Section: Preventive Strategiesmentioning

confidence: 98%

“…In a clinical setting, an interesting preventive study has been conducted by Arora et al [49] . The specific aims of this study were to adapt the Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs) [50] to evaluate hospital care in a sample of vulnerable elderly patients.…”

Section: Preventive Strategiesmentioning

confidence: 99%

Frailty Syndrome: A Transitional State in a Dynamic Process

2009

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Frailty has long been considered synonymous with disability and comorbidity, to be highly prevalent in old age and to confer a high risk for falls, hospitalization and mortality. However, it is becoming recognized that frailty may be a distinct clinical syndrome with a biological basis. The frailty process appears to be a transitional state in the dynamic progression from robustness to functional decline. During this process, total physiological reserves decrease and become less likely to be sufficient for the maintenance and repair of the ageing body. Central to the clinical concept of frailty is that no single altered system alone defines it, but that multiple systems are involved. Clinical consensus regarding the phenotype which constitutes frailty, drawing upon the opinions of numerous authors, shows the characteristics to include wasting (loss of both muscle mass and strength and weight loss), loss of endurance, decreased balance and mobility, slowed performance, relative inactivity and, potentially, decreased cognitive function. Frailty is a distinct entity easily recognized by clinicians, with multiple manifestations and with no single symptom being sufficient or essential in its presentation. Manifestations include appearance (consistent or not with age), nutritional status (thin, weight loss), subjective health rating (health perception), performance (cognition, fatigue), sensory/physical impairments (vision, hearing, strength) and current care (medication, hospital). Although the early stages of the frailty process may be clinically silent, when depleted reserves reach an aggregate threshold leading to serious vulnerability, the syndrome may become detectable by looking at clinical, functional, behavioral and biological markers. Thus, a better understanding of these clinical changes and their underlying mechanisms, beginning in the pre-frail state, may confirm the impression held by many geriatricians that increasing frailty is distinguishable from ageing and in consequence is potentially reversible. We therefore provide an update of the physiopathology and clinical and biological characteristics of the frailty process and speculate on possible preventative approaches.

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“…Frailty is partly responsible for the oldest patients having the highest readmission rates, highest rate of use of long-term care after discharge and longest lengths of stay (58). Admission to hospital also adds specific hazards (e.g.…”

Section: Efficacy Of Comprehensive Geriatric Assessmentmentioning

confidence: 99%

Frailty Assessment in Acute Care

2015

The Gerontologist

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IntroductionFor some people, ageing is associated with the experience of increased co-morbidity, functional impairment, poor resilience and heightened vulnerability to external stressors, resulting in reduced lifespan as well as health-span. This frailty phenomenon poses challenges to health care systems in the form of increased patient complexity and resource utilisation. The acute care setting, characterised by time-pressure and high patient turn-over, is under strain and struggles to recognise and subsequently reliably intervene, to prevent, reverse or halt the decline of this vulnerable cohort. MethodsThis mixed-methods study probes existing evidence and 'real-world' processes with a systematic review of frailty assessments developed or validated in the acute care setting and a survey of contemporaneous clinical practice in London Acute Medical Units. Content validation and understanding of contextual factors for ideal frailty assessment in acute care is explored using Delphi consensus and Focus Group methodology respectively. The resultant model is developed on existing retrospective national Hospital Episode Statistics data, and prospectively tested on observational data in a local Acute Medical Unit setting. ResultsExisting frailty scores are preponderantly biophysical in nature, and have poor predictive power for adverse outcomes in the acute care setting. In clinical practice, single-dimension assessment tools predominate. Frailty syndromes and previous high resource utilisation in the form of a simple, clinically relevant tool useful to the multidisciplinary team gain consensus as optimal assessment for the setting. Retrospective testing of the frailty model displays moderate predictive powers for adverse events (inpatient mortality, emergency readmission and institutionalisation) and prospective testing provides concurrent (Frailty Index, Age, Co-Morbidity) and comparative predictive validity (Frailty Index, Co-Morbidity, 2 admission National Early Warning Score) with existing risk stratification models in this setting. ConclusionsA risk prediction model based on frailty syndromes and previous high resource utilisation is a valid, feasible and useful for the acute care setting.

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Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

Abstract: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care.

Cited by 83 publications

References 24 publications

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Frailty Syndrome: A Transitional State in a Dynamic Process

Frailty Assessment in Acute Care

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