Background:
Measuring the quality of hospital care for elderly patients is important since elderly patients are at risk for certain hospital‐related hazards, such as delirium. The Assessing Care of the Vulnerable Elders (ACOVE) Project has developed quality indicators (QIs), that have been endorsed for use in pay‐for‐performance (P4P) programs, to measure the quality of care for frail elders. Although these QIs have been used in community‐dwelling adults, they have not been used in a cohort of hospitalized patients. This study aims to use ACOVE‐based measures to assess quality of care for hospitalized vulnerable elders.
Method:
All patients age 65 or older hospitalized on the University of Chicago inpatient general medicine services were approached for an interview using the VES‐13, a 13 item validated tool based on age, self‐reported health and functional status. Patients scoring 3 or higher were defined as vulnerable and eligible for chart reviews. Those ACOVE QI's that were judged feasible to collect and relevant for our patient population were incorporated into a chart review. Percent adherence was calculated by dividing the number of eligible patients who passed the indicator by the number of patients eligible for that indicator. Adherence for general medical (e.g. pain, etc.) and geriatric‐specific conditions (e.g. pressure ulcers, etc) was compared using two‐sample tests of proportions. Adherence by type of care (screening, treatment, and diagnosis) and provider (doctor, nurse) was also calculated.
Summary of Results:
834/984(85%) patients participated. Of these, 423(51%) were deemed vulnerable. 298(71%) charts were available for review. Sixteen QIs that measured care in the domains of general medical care, pressure ulcer care, and dementia were selected for review. QIs for general medical care were met at a rate of 88% (1227/1403), significantly higher than for geriatric‐specific conditions [dementia 80% (458/569) and pressure ulcers 65% (344/527)] (p < 0.001 for both). Screening indicators were performed almost universally [99.6% (467/469)] and more often than diagnostic indicators [51% (183/357)] and therapeutic indicators [71% (314/441)] (p < 0.001 for both compared to screening). Nurses, by using a standard nursing assessment form, outperformed doctors on each of the screening indicators (e.g. cognitive and functional status, pain, nutrition, pressure ulcers, etc.) (p < 0.001 for all). Yet, functional screening by nurses was less likely to be accurate (when compared to patient self‐report) than screenings by doctors [RN correct 233/403 (58%) vs. MD correct 73/88 (83%), p < 0.001]
Statement of Conclusions:
Quality of geriatric‐specific hospital care is worse than for general hospital care. Although screening QIs are often met by nurses completing standard forms, these assessments may be incorrect. This may have implications for the use of screening QIs in P4P programs.
Author Disclosure Block:
V. Arora, None; M. Johnson, None; P. Podrazik, None; S. Levine, None; G. Sachs, None; D. Meltzer, None.