Background:
Today, Medicare patients account for approximately 50% of hospital days, costing $1 trillion annually. Despite this staggering financial burden, hospitalization often results in poor outcomes for older adults. The objective of the study was to test the feasibility and impact of using Assessing Care of Vulnerable Elders (ACOVE) Quality Indicators (QIs) as a therapeutic intervention to improve care of hospitalized older adults.
Methods:
The study was a posttest only prospective intervention with a non-equivalent retrospective control group, in a large tertiary hospital in the greater New York Metropolitan area. Participants included all hospitalized patients, 75 and over, admitted to medical units. The intervention consisted of a checklist, comprised of four ACOVE QIs, administered during daily interdisciplinary rounds: venous thrombosis prophylaxis (VTE) (QI 1), indwelling bladder catheters (QI 2), mobilization (QI 3), and delirium evaluation (QI 4). Variables were extracted from electronic medical records with QI compliance as primary outcome, and length-of-stay, discharge disposition and readmissions as secondary outcomes. A generalized linear mixed model for binary clustered data was used to estimate compliance rates for each group (intervention group or control group) in the post-Intervention period, along with their corresponding 95% CIs.
Results:
Of the 2,396 patients, 530 were on an intervention unit and 1,866 on control. In those patients not already compliant with venous thrombosis prophylaxis (QI 1), compliance rate was 57% in intervention vs. 39% in control (p<0.0056). In the 406 patients with indwelling catheters, compliance with the catheterization (QI 2) was 72.2% vs. 54.4% (p=0.1061), reaching significance in patients with prolonged hospitalization (p=0.0006). For mobilization (QI 3), overall compliance was significantly higher in the intervention group (62.9% vs. 48.2%, p<0.0001). For delirium evaluation (QI 4), overall documentation was significantly higher in the intervention group (27.9% vs. 21.7%, p=0.0027).
Conclusions: The study demonstrates the feasibility and effectiveness of integrating ACOVE QIs, as an evidence-based intervention, to facilitate decision support during interdisciplinary rounds, and improve quality of care in hospitalized older adults. Utilizing a checklist-based tool at the bedside allows the multidisciplinary team to implement evidence-based practices with the ultimate goal of standardizing care, not only for older adults, but potentially for other high risk populations with multi-morbidity. This innovative approach provides much needed direction to health care providers in the ever increasing stressful conditions of today’s acute care environment, for the ultimate benefit and safety of our older patients.