Effects of provider practice on functional independence in older adults.
OBJECTIVE
To examine provider determinants of new-onset disability in basic activities of daily living (ADLs) in community-dwelling elderly.


METHODS
Observational study.


METHODS
King County, Washington.


METHODS
A random sample of 800 health maintenance organization (HMO) enrollees aged 65 and older participating in a prospective longitudinal cohort study of dementia and normal aging and their 56 primary care providers formed the study population.


METHODS
Incident ADL disability, defined as any new onset of difficulty performing any of the basic ADLs at follow-up assessments, was examined in relation to provider characteristics and practice style using logistic regression and adjusting for case-mix, patient and provider factors associated with ADL disability, and clustering by provider.


RESULTS
Neither provider experience taking care of large numbers of elderly patients nor having a certificate of added qualifications in geriatrics was associated with patient ADL disability at 2 or 4 years of follow-up (adjusted odds ratio (AOR) for experience=1.29, 95% confidence interval (CI)=0.81-2.05; AOR for added qualifications=0.72, 95% CI=0.38-1.39; results at 4 years analogous). A practice style embodying traditional geriatric principles of care was not associated with a reduced likelihood of ADL disability over 4 years of follow-up (AOR for prescribing no high-risk medications=0.56, 95% CI=0.16-1.94; AOR for managing geriatric syndromes=0.94, 95% CI=0.40-2.19; AOR for a team care approach=1.35, 95% CI=0.66-2.75).


CONCLUSIONS
Taking care of a large number of elderly patients, obtaining a certificate of added qualifications in geriatrics, and practicing with a traditional geriatric orientation do not appear to influence the development of ADL disability in elder, community dwelling HMO enrollees.
Phelan
Elizabeth A
EA
Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington 98104, USA. phelane@u.washington.edu
Williams
Barbara
B
LaCroix
Andrea Z
AZ
Grothaus
Lou
L
LoGerfo
James P
JP
Wagner
Edward H
EH
D000203:Activities of Daily Living; D000368:Aged; D002568:Certification; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies