title: Contrasting effects of geriatric versus general medical multimorbidity on quality of ambulatory care.
abstract: OBJECTIVE
  To determine whether greater burden of geriatric conditions would have contrasting effects on quality of care (QOC) than nongeriatric, general medical conditions.
  
  
  METHODS
  Cross-sectional observation over 1 year of ambulatory care.
  
  
  METHODS
  The Assessing Care of Vulnerable Elders-2 study.
  
  
  METHODS
  Older adults prospectively screened for falls, incontinence, and dementia (N = 644).
  
  
  METHODS
  Participant-level QOC in absolute percentage points calculated using 65 ambulatory care care-process quality indicators (QIs) for 13 general medical and geriatric conditions (#QIs provided/#QIs eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QIs) and medical QOC (the 27 remaining nongeriatric QIs). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site.
  
  
  RESULTS
  Medical and geriatric comorbidity were unrelated to each other (correlation coefficient = 0.04, P = .27) yet had opposite effects on QOC. Each additional medical condition was associated with a 3.2-percentage point (95% confidence interval (CI) = 2.3-4.2 percentage point) increment in QOC, and each additional geriatric condition was associated with 4.9-percentage point (95% CI = 3.5-6.5 percentage point) decrement in QOC. Participants with greater geriatric comorbidity received poorer medical and geriatric QOC.
  
  
  CONCLUSIONS
  Greater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC. Geriatric multimorbidity should be targeted for better care using a comprehensive approach.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Geriatrics Research, Education and Clinical Care Center, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan.
authors.forename: Lillian
authors.initials: L
authors.lastname: Min
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Blaum
authors.forename: David
authors.initials: D
authors.lastname: Reuben
authors.forename: Christine
authors.initials: C
authors.lastname: Cigolle
authors.forename: Neil
authors.initials: N
authors.lastname: Wenger
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: aging; multimorbidity; quality of care