Clinic systems and the quality of care for older adults in residency clinics and in physician practices.
OBJECTIVE
The U.S. health care system is not prepared to meet the needs of the increasing population of older adults. Few physicians become geriatricians, but most will care for older adults. The authors assessed the quality of care for older adults in residency clinics and physician practices.


METHODS
Using the American Board of Internal Medicine's Care of the Vulnerable Elderly practice improvement module, researchers studied the quality of care provided to older adults in 52 internal and family medicine residency clinic sites and by a motivated group of 144 practicing physicians from 2006 to 2008. They also studied the characteristics of the practice systems in the clinics and offices and the relationship between specific elements of practice systems and the quality of care.


RESULTS
Patients seen by residents were younger, had fewer chronic conditions, and were less likely to receive recommended care. Residency clinic systems were less likely to have elements designed to support care for older adults. Even when present, there was little correlation with care provided. Practicing physicians were more likely to provide recommended processes of care, and system elements in their practices were more likely to function well and correlate with delivery of key processes of care, but much room for improvement remains.


CONCLUSIONS
Practice system elements designed to support care for older adults perform differently in residency clinics than in practicing physicians' offices. Significant gaps in the quality of care for older adults exist and are much more pronounced in the residency clinic setting.
Lynn
Lorna A
LA
Department of Quality Research, American Board of Internal Medicine, Philadelphia, Pennsylvania 19106, USA. LLynn@ABIM.ORG
Hess
Brian J
BJ
Conforti
Lisa N
LN
Lipner
Rebecca S
RS
Holmboe
Eric S
ES
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005194:Family Practice / Q000193:education*; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017064:Process Assessment, Health Care; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*