title: Quality-of-care processes in geriatric assessment units: principles, practice, and outcomes.
abstract: OBJECTIVE
  To assess quality-of-care processes and to examine whether care processes are associated with short-term postdischarge outcomes in older vulnerable hospitalized patients.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Forty-nine Geriatric Assessment Units.
  
  
  METHODS
  Patients aged 65 and older who were admitted to a Geriatric Assessment Unit for a fall with trauma.
  
  
  METHODS
  Three care processes (comprehensiveness, informational continuity, patient-centered care) assessed through chart audit; three-month postdischarge outcomes (emergency department visit, hospital readmission, and death) obtained from national databases.
  
  
  RESULTS
  A total of 934 hospitalization records were included. Mean comprehensiveness and informational continuity scores were 55% ± 12% and 42% ± 16%, respectively. Items related to geriatric global assessment (eg, functional autonomy) were particularly overlooked. Patient-centered care was poorly provided, with only 24% of hospitalization records showing evidence of advance care directives and at least one patient/family meeting with the physician to discuss clinical evolution. For the three care processes, a large variability among Geriatric Assessment Units was observed. Better comprehensiveness of care was associated with lowered short-term mortality (OR = 0.73, 95% CI = 0.55-0.96, P = .023), whereas higher scores on informational continuity was associated with fewer emergency department visits (OR = 0.91, 95% CI = 0.82-1.00, P = .046), hospital readmissions (OR = 0.84, 95% CI = 0.74-0.94, P = .003), and mortality (OR = 0.72, 95% CI = 0.59-0.88, P = .002). Patient-centered care was not associated with any of the postdischarge outcomes.
  
  
  CONCLUSIONS
  A large gap between geriatric care principles and practice in Geriatric Assessment Units has been observed. Our results show that improvement in care processes may be translated to decreased short-term health services use and mortality.
authors.affiliation: Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada. marie-jeanne.kergoat@umontreal.ca
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Kergoat
authors.forename: Judith
authors.initials: J
authors.lastname: Latour
authors.forename: Paule
authors.initials: P
authors.lastname: Lebel
authors.forename: Bernard-Simon
authors.initials: BS
authors.lastname: Leclerc
authors.forename: Nicole
authors.initials: N
authors.lastname: Leduc
authors.forename: François
authors.initials: F
authors.lastname: Béland
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.forename: Nancy
authors.initials: N
authors.lastname: Presse
authors.forename: Anaïs
authors.initials: A
authors.lastname: Tanon
authors.forename: Aline
authors.initials: A
authors.lastname: Bolduc
mesh_terms: D000058:Accidental Falls; D000368:Aged; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007297:Inpatients; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care / Q000379:methods; D011787:Quality of Health Care / Q000458:organization & administration*; D011792:Quebec; D012189:Retrospective Studies; D014947:Wounds and Injuries