title: Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma.
abstract: BACKGROUND
  Older trauma-injury patients had improved recovery after we implemented routine geriatric consultation for patients aged 65 years and older admitted to the trauma service of a Level I academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown.
  
  
  METHODS
  We conducted a prospective observation comparing medical care after (December 2007 to November 2009) vs before (December 2006 to November 2007) implementation of the geriatric consult-based intervention. To measure quality of care (QOC), we used 33 previously validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 geriatric consult (GC) vs 71 control group patients. As prespecified subgroup analyses, we aggregated QIs by type: geriatric (eg, delirium screening) vs nongeriatric condition-based care (eg, thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and nongeriatric QOC scores for each patient (number of QIs passed/number of QIs eligible), and compared patient-level QOC for the GC vs control group, adjusting for age, sex, ethnicity, comorbidity, and injury severity.
  
  
  RESULTS
  Sixty-three percent of the GC patients vs 11% of the control group patients received a geriatric consultation. We evaluated 2,505 QIs overall (1,664 geriatric type and 841 nongeriatric QIs). In general, fewer geriatric-type QIs were passed than nongeriatric QIs (71% vs 81%; p < 0.001). We provided better overall QOC to the GC (77%) than control group patients (73%; p < 0.05). However, the difference was not statistically significant after multivariable adjustment (p = 0.08). We improved geriatric QOC for the GC (74%) compared with the control group (68%; p < 0.01), a difference that was significant after multivariable adjustment (p = 0.01).
  
  
  CONCLUSIONS
  Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI; Geriatric Research Education and Clinical Center (GRECC), VA Health Care Systems, Ann Arbor, MI. Electronic address: lmin@med.umich.edu.
authors.forename: Lillian
authors.initials: L
authors.lastname: Min
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Henry
authors.initials: H
authors.lastname: Cryer
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Chiao-Li
authors.initials: CL
authors.lastname: Chan
authors.affiliation: RAND Health, Santa Monica, CA.
authors.forename: Carol
authors.initials: C
authors.lastname: Roth
authors.affiliation: Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Areti
authors.initials: A
authors.lastname: Tillou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation / Q000592:standards*; D014193:Trauma Centers / Q000592:standards*; D014947:Wounds and Injuries / Q000628:therapy*
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