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Introduction to the Assessing Care of Vulnerable Elders-3 Quality Indicator Measurement Set

Authors

  • Neil S. Wenger MD, MPH,

    1. From the *RAND Health, Santa Monica, CaliforniaDivision of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CaliforniaVeteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • Carol P. Roth RN, MPH,

    1. From the *RAND Health, Santa Monica, CaliforniaDivision of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CaliforniaVeteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • Paul Shekelle MD, PhD,

    1. From the *RAND Health, Santa Monica, CaliforniaDivision of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CaliforniaVeteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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  • the ACOVE Investigators

    1. From the *RAND Health, Santa Monica, CaliforniaDivision of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, CaliforniaVeteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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    • **For full list of ACOVE investigators see Appendix A.


Address correspondence to Neil S. Wenger, MD, RAND Health, 1776 Main Street, Santa Monica, CA 90407. E-mail: nwenger@mednet.ucla.edu

Abstract

OBJECTIVES: To update and increase the comprehensiveness of the Assessing Care of Vulnerable Elders (ACOVE) set of process-of-care quality indicators (QIs) for the medical care provided to vulnerable elders and to keep up with the constantly changing medical literature, the QIs were revised and expanded.

DESIGN: The ACOVE Clinical Committee expanded the number of measured conditions to 26 in the revised (ACOVE-3) set. For each condition, a content expert created potential QIs and, based on systematic reviews, developed a peer-reviewed monograph detailing each QI and its supporting evidence. Using these literature reviews, multidisciplinary panels of clinical experts participated in two rounds of anonymous ratings and a face-to-face group discussion to evaluate whether the QIs were valid measures of quality of care using a process that is an explicit combination of scientific evidence and professional consensus. The Clinical Committee evaluated the coherence of the complete set of QIs that the expert panels rated as valid.

RESULTS: ACOVE-3 contains 392 QIs covering 14 different types of care processes (e.g., taking a medical history, performing a physical examination) and all four domains of care: screening and prevention (31% of QIs), diagnosis (20%), treatment (35%), and follow-up and continuity (14%). All QIs also apply to community-dwelling patients aged 75 and older.

CONCLUSION: ACOVE-3 contains a set of QIs to comprehensively measure the care provided to vulnerable older persons at the level of the health system, health plan, or medical group. These QIs can be applied to identify areas of care in need of improvement and can form the basis of interventions to improve care.

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