Predictors of overall quality of care provided to vulnerable older people.
OBJECTIVE
Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated.


METHODS
Observational cohort study.


METHODS
Two senior managed care plans.


METHODS
Three hundred sixty-two community-dwelling patients aged 65 and older identified as vulnerable by the Vulnerable Elder Survey (VES-13).


METHODS



METHODS
patients' observed-minus-expected overall quality score.


METHODS
types of care processes, types and number of clinical conditions, sex, age, VES-13 score (composite score of function and self-rated health), income, education, mental health status, and number of quality indicators triggered.


RESULTS
Patients whose conditions required more history-taking, counseling, and medication-prescribing care processes and patients with diabetes mellitus received lower-than-expected quality of care. A greater number of comorbid conditions was associated with higher-than-expected quality of care. Age, sex, VES-13 score, and other sociodemographic variables were not associated with quality of care.


CONCLUSIONS
Complexity, vulnerability, and age do not predispose older persons to receive poorer-quality care. In contrast, older patients whose care requires time-consuming processes such as history taking and counseling are at risk for worse quality of care and should be a target for intervention to improve care.
Min
Lillian C
LC
Division of Geriatrics, University of California at Los Angeles, Los Angeles, California 90095, USA. lmin@mednet.ucla.edu
Reuben
David B
DB
MacLean
Catherine H
CH
Shekelle
Paul G
PG
Solomon
David H
DH
Higashi
Takahiro
T
Chang
John T
JT
Roth
Carol P
CP
Kamberg
Caren J
CJ
Adams
John
J
Young
Roy T
RT
Wenger
Neil S
NS
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008487:Medical History Taking / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data*