Restructuring Primary Care Practices to Manage Geriatric Syndromes: The ACOVE-2 Intervention

Authors

  • David B. Reuben MD,

    1. From the *Multicampus Program in Geriatric Medicine and GerontologyDivision of General Internal Medicine and Health Services Research, The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaRAND Health, Santa Monica, California§RAND Health, Arlington, Virginia.
    Search for more papers by this author
  • Carol Roth RN, MPH,

    1. From the *Multicampus Program in Geriatric Medicine and GerontologyDivision of General Internal Medicine and Health Services Research, The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaRAND Health, Santa Monica, California§RAND Health, Arlington, Virginia.
    Search for more papers by this author
  • Caren Kamberg MSPH,

    1. From the *Multicampus Program in Geriatric Medicine and GerontologyDivision of General Internal Medicine and Health Services Research, The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaRAND Health, Santa Monica, California§RAND Health, Arlington, Virginia.
    Search for more papers by this author
  • Neil S. Wenger MD, MPH

    1. From the *Multicampus Program in Geriatric Medicine and GerontologyDivision of General Internal Medicine and Health Services Research, The David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CaliforniaRAND Health, Santa Monica, California§RAND Health, Arlington, Virginia.
    Search for more papers by this author

  • This project was supported by a contract from Pfizer Inc. to RAND.

Address correspondence to David B. Reuben, MD, Multicampus Program in Geriatric Medicine and Gerontology, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095. E-mail: dreuben@mednet.ucla.edu

Abstract

Despite evidence suggesting that primary care physicians do not address geriatric conditions adequately in practice, most efforts to change physicians' practice behaviors have been ineffective or too expensive to implement and sustain.

In its second phase, the Assessing Care of the Vulnerable Elders (ACOVE-2) project has developed an intervention aimed at improving the care that primary care physicians provide for three geriatric conditions—falls, urinary incontinence, and cognitive impairment/dementia. The intervention addresses specific processes of care identified in the first phase of the ACOVE project (ACOVE-1) as important to the care of community-dwelling older persons. Beginning with case finding, the intervention uses a standardized multicomponent practice-change effort. The condition-specific intervention employs four methods of changing medical practice: efficient collection of condition-specific clinical data, medical record prompts to encourage performance of essential care processes, patient education materials and activation of the patient's role in follow-up, and physician decision support and physician education. Moreover, the costs of the intervention are low. The effectiveness of the intervention in improving the processes of care for these conditions and clinical outcomes will need to be evaluated in controlled trials.

Ancillary