Using assessing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders.
OBJECTIVE
To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).


METHODS
Prospective cohort study.


METHODS
Single academic medical center.


METHODS
Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status.


METHODS
Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse).


RESULTS
Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3-83.7% vs 75.8%, 95% CI=70.5-81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3-83.7 vs 31.4% 95% CI=27.5-35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission.


CONCLUSIONS
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.
Arora
Vineet M
VM
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA. varora@medicine.bsd.uchicago.edu
Johnson
Martha
M
Olson
Jared
J
Podrazik
Paula M
PM
Levine
Stacie
S
Dubeau
Catherine E
CE
Sachs
Greg A
GA
Meltzer
David O
DO
D000368:Aged; D000369:Aged, 80 and over; D002641:Chicago; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003693:Delirium / Q000453:epidemiology / Q000628:therapy; D003704:Dementia / Q000453:epidemiology / Q000628:therapy; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008403:Mass Screening; D003668:Pressure Ulcer / Q000453:epidemiology / Q000628:therapy; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*