The quality of medical care provided to vulnerable community-dwelling older patients.
BACKGROUND
Many people 65 years of age and older are at risk for functional decline and death. However, the resource-intensive medical care provided to this group has received little evaluation. Previous studies have focused on general medical conditions aimed at prolonging life, not on geriatric issues important for quality of life.


OBJECTIVE
To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators (QIs).


METHODS
Observational cohort study.


METHODS
Managed care organizations in the northeastern and southwestern United States.


METHODS
Vulnerable older patients identified by a brief interview from a random sample of community-dwelling adults 65 years of age or older who were enrolled in 2 managed care organizations and received care between July 1998 and July 1999.


METHODS
Percentage of 207 QIs passed, overall and for 22 target conditions; by domain of care (prevention, diagnosis, treatment, and follow-up); and by general medical condition (for example, diabetes and heart failure) or geriatric condition (for example, falls and incontinence).


RESULTS
Patients were eligible for 10 711 QIs, of which 55% were passed. There was no overall difference between managed care organizations. Wide variation in adherence was found among conditions, ranging from 9% for end-of-life care to 82% for stroke care. More treatment QIs were completed (81%) compared with other domains (follow-up, 63%; diagnosis, 46%; and prevention, 43%). Adherence to QIs was lower for geriatric conditions than for general medical conditions (31% vs. 52%; P < 0.001).


CONCLUSIONS
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.
Wenger
Neil S
NS
RAND Health, Santa Monica, California, USA. nwenger@mednet.ucla.edu
Solomon
David H
DH
Roth
Carol P
CP
MacLean
Catherine H
CH
Saliba
Debra
D
Kamberg
Caren J
CJ
Rubenstein
Laurence Z
LZ
Young
Roy T
RT
Sloss
Elizabeth M
EM
Louie
Rachel
R
Adams
John
J
Chang
John T
JT
Venus
Patricia J
PJ
Schnelle
John F
JF
Shekelle
Paul G
PG
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008329:Managed Care Programs; D009511:New England; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D015206:Southwestern United States