Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions.
The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician-performed tasks, 0.55 for nurse practitioner (NP)-, physician assistant (PA)-, and registered nurse (RN)-performed tasks; and 0.61 for medical assistant- and licensed vocational nurse-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults.
Department of Medicine, Section of Hospital Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Brian J
BJ
Lichtenstein
Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
David B
DB
Reuben
Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Arun S
AS
Karlamangla
Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Weijuan
W
Han
RAND Health, Santa Monica, California.
Carol P
CP
Roth
RAND Health, Santa Monica, California.|Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Neil S
NS
Wenger
D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006282:Health Personnel / Q000592:standards*; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D032024:Personnel Delegation / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D014481:United States
geriatric health services; geriatrics; personnel delegation; quality of health care