Predictors of quality-of-care processes in geriatric assessment units: toward a better organizational framework.
OBJECTIVE
To identify the structural and patient characteristics associated with better care processes in older vulnerable hospitalized patients.


METHODS
Retrospective study.


METHODS
Forty-four Geriatric Assessment Units (GAU).


METHODS
Patients aged 65 and older who were admitted to a GAU for a fall with trauma.


METHODS
Three care processes (comprehensiveness, informational continuity, completion of advance health care directives) assessed through chart audit; 14 patient- and 23 GAU-related characteristics obtained from hospitalization records, national databases, and GAU managers.


RESULTS
A total of 877 hospitalization records were included. Final models were based on multilevel modeling using stepwise variable selection. Strongest predictors of better comprehensiveness were longer hospital length of stay (LOS), higher clinical complexity (eg, higher mortality risk), and having a geriatrician as attending physician. Comprehensiveness score increased sharply up to 3 weeks LOS and then tended to plateau. Better informational continuity was associated with more comprehensive care, higher risk of mortality, acute rather than rehabilitation care, communication with community health care professionals within 48 hours after admission, and a target LOS of 3 weeks or longer. The completion of advance directives was more likely in the presence of advanced age, higher risk of mortality, cognitive impairment, discharge to another care facility, longer LOS, university-affiliated institution, and nonurban location.


CONCLUSIONS
In GAUs, quality-of-care processes are related to both structural and patient characteristics. Our results pointed toward an organizational framework that may help to streamline the geriatric units and better use resources, notably by narrowing the admission criteria, targeting a proper LOS, improving communication with community organizations, and making systematic completion of advance directives.
Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada. marie-jeanne.kergoat@umontreal.ca
Marie-Jeanne
MJ
Kergoat
Judith
J
Latour
Nancy
N
Presse
Paule
P
Lebel
François
F
Béland
Bernard-Simon
BS
Leclerc
Nicole
N
Leduc
Katherine
K
Berg
Aline
A
Bolduc
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008297:Male; D016017:Odds Ratio; D011787:Quality of Health Care / Q000458:organization & administration*; D011792:Quebec; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000175:diagnosis