Relationship between quality of care and functional decline in hospitalized vulnerable elders.
BACKGROUND
Although process of care is a valuable dimension of quality, process-of-care-based quality indicators (POC-QIs) are ideally associated with meaningful patient outcomes. The relationship between POC-QIs for hospitalized older patients and functional decline, a relevant outcome for older patients, is unknown.


OBJECTIVE
To assess the relationship between POC-QIs for hospitalized elders and functional decline.


METHODS
Observational cohort study.


METHODS
Hospitalized vulnerable elder patients age 65 or older admitted to a general medicine inpatient service from June 1, 2004 to June 1, 2007.


METHODS
POC-QIs received by hospitalized patients (measured by Assessing Care of Vulnerable Elders QIs) and functional decline (increased activities of daily living impairments postdischarge).


RESULTS
For 898 vulnerable elder patients, mean adherence to 6 universally applied quality indicators was 57.8%. After adjustment for factors likely associated with functional decline (comorbidity, vulnerability, baseline functional limitation, number of POC-QIs triggered, length of stay, code status, and interaction between frailty and QI adherence), there was no association higher quality of care (using the composite score) and increased risk of functional decline. Patients who received a mobility plan were 1.48 (95% CI: 1.07-2.05; P = 0.017) times more likely to suffer functional decline after discharge. Patients who received an assessment of nutritional status had a lower odds of suffering functional decline after discharge (OR: 0.37, [95% CI: 0.21-0.64; P < 0.001]).


CONCLUSIONS
Hospitalized vulnerable elders who receive higher quality of care, as measured by Assessing Care of Vulnerable Elders QIs, are not less likely to suffer decline after discharge.
Arora
Vineet M
VM
Department of Medicine, Section of General Medicine, University of Chicago, Chicago, Illinois 60637, USA. varora@medicine.bsd.uchicago.edu
Plein
Colleen
C
Chen
Stuart
S
Siddique
Juned
J
Sachs
Greg A
GA
Meltzer
David O
DO
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D035862:Vulnerable Populations