Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition.
BACKGROUND
The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).


METHODS
The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002-2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.


RESULTS
Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.


CONCLUSIONS
Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.
Kergoat
Marie-Jeanne
MJ
Research Centre, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada. marie-jeanne.kergoat@umontreal.ca
Leclerc
Bernard-Simon
BS
Leduc
Nicole
N
Latour
Judith
J
Berg
Katherine
K
Bolduc
Aline
A
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015577:Geriatric Assessment / Q000379:methods; D005853:Geriatrics / Q000379:methods / Q000592:standards*; D006801:Humans; D005791:Patient Care / Q000379:methods / Q000592:standards; D010346:Patient Care Management / Q000379:methods / Q000592:standards*; D010865:Pilot Projects; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies