title: Self-reported quality of care for older adults from 2004 to 2011: a cohort study.
abstract: BACKGROUND
  little is known about changes in the quality of medical care for older adults over time.
  
  
  OBJECTIVE
  to assess changes in technical quality of care over 6 years, and associations with participants' characteristics.
  
  
  METHODS
  a national cohort survey covering RAND Corporation-derived quality indicators (QIs) in face-to-face structured interviews in participants' households.
  
  
  METHODS
  a total of 5,114 people aged 50 or more in four waves of the English Longitudinal Study of Ageing.
  
  
  METHODS
  the percentage achievement of 24 QIs in 10 general medical and geriatric clinical conditions was calculated for each time point, and associations with participants' characteristics were estimated using logistic regression.
  
  
  RESULTS
  participants were eligible for 21,220 QIs. QI achievement for geriatric conditions (cataract, falls, osteoarthritis and osteoporosis) was 41% [95% confidence interval (CI): 38-44] in 2004-05 and 38% (36-39) in 2010-11. Achievement for general medical conditions (depression, diabetes mellitus, hypertension, ischaemic heart disease, pain and cerebrovascular disease) improved from 75% (73-77) in 2004-05 to 80% (79-82) in 2010-11. Achievement ranged from 89% for cerebrovascular disease to 34% for osteoarthritis. Overall achievement was lower for participants who were men, wealthier, infrequent alcohol drinkers, not obese and living alone.
  
  
  CONCLUSIONS
  substantial system-level shortfalls in quality of care for geriatric conditions persisted over 6 years, with relatively small and inconsistent variations in quality by participants' characteristics. The relative lack of variation by participants' characteristics suggests that quality improvement interventions may be more effective when directed at healthcare delivery systems rather than individuals.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Steel
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Antonia C
authors.initials: AC
authors.lastname: Hardcastle
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Allan
authors.initials: A
authors.lastname: Clark
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: Luke T A
authors.initials: LT
authors.lastname: Mounce
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
authors.forename: Max O
authors.initials: MO
authors.lastname: Bachmann
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Richards
authors.affiliation: Health Statistics Group, University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, UK.
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
authors.affiliation: Epidemiology and Public Health, University of Exeter Medical School, Barrack Road, Exeter, Devon, UK.
authors.forename: David
authors.initials: D
authors.lastname: Melzer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D016009:Chi-Square Distribution; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D004739:England; D005260:Female; D019538:Health Care Surveys; D006299:Health Services for the Aged / Q000592:standards / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000639:trends*; D057566:Self Report; D013997:Time Factors
keywords: epidemiology; geriatrics; older people; quality of care