Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

Authors

  • Vineet M. Arora MD, MA,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Martha Johnson BS,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Jared Olson BS,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Paula M. Podrazik MD,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Stacie Levine MD,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Catherine E. DuBeau MD,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • Greg A. Sachs MD,

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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  • David O. Meltzer MD, PhD

    1. From the Sections of *General Internal Medicine and Geriatrics, Department of MedicinePritzker School of Medicine, and Departments of §Economics#Public Policy Studies, University of Chicago, Chicago, Illinois.
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Address correspondence to Vineet M. Arora, MD, MA, University of Chicago, 5841 S. Maryland Ave. MC 2007, AMB W216, Chicago, IL 60637. E-mail: varora@medicine.bsd.uchicago.edu

Abstract

OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).

DESIGN: Prospective cohort study.

SETTING: Single academic medical center.

PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status.

MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse).

RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3–83.7% vs 75.8%, 95% CI=70.5–81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3–83.7 vs 31.4% 95% CI=27.5–35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission.

CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care.

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