title: Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality.
abstract: OBJECTIVE
  To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Single academic medical center.
  
  
  METHODS
  Patients aged 65 and older who were identified as "vulnerable" using the Vulnerable Elder Survey (VES-13).
  
  
  METHODS
  Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index.
  
  
  RESULTS
  One thousand eight hundred fifty-six inpatient vulnerable older adults were enrolled. Mean quality-of-care score was 59.5 ± 19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES-13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87-1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1-year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68-1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40-0.93; P=.02).
  
  
  CONCLUSIONS
  Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.
authors.affiliation: Section of General Medicine, Department of Medicine, Harris School of Public Policy Studies, University of Chicago, Chicago, Illinois, USA. varora@medicine.bsd.uchicago.edu
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
authors.forename: Melissa
authors.initials: M
authors.lastname: Fish
authors.forename: Anirban
authors.initials: A
authors.lastname: Basu
authors.forename: Jared
authors.initials: J
authors.lastname: Olson
authors.forename: Colleen
authors.initials: C
authors.lastname: Plein
authors.forename: Kalpana
authors.initials: K
authors.lastname: Suresh
authors.forename: Greg
authors.initials: G
authors.lastname: Sachs
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007297:Inpatients; D008297:Male; D010351:Patient Discharge; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D035862:Vulnerable Populations