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Does Better Quality of Care for Falls and Urinary Incontinence Result in Better Participant-Reported Outcomes?

Authors

  • Lillian C. Min MD, MSHS,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • David B. Reuben MD,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • John Adams PhD,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • Paul G. Shekelle MD, PhD,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • David A. Ganz MD, PhD,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • Carol P. Roth RN, MPH,

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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  • Neil S. Wenger MD

    1. From the *Division of Geriatrics, University of Michigan Medical School, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Healthcare System, Geriatrics Research, Education and Clinical Care Center, Ann Arbor, Michigan; RAND Health, Santa Monica, California; §David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
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Address correspondence to Lillian Min, 300 North Ingalls Bldg, Wing E Room 966, Ann Arbor, MI 48109. E-mail: lmin@med.umich.edu

Abstract

OBJECTIVES: To determine whether delivery of better quality of care for urinary incontinence (UI) and falls is associated with better participant-reported outcomes.

DESIGN: Retrospective cohort study.

SETTING: Assessing Care of Vulnerable Elders Study 2 (ACOVE-2).

PARTICIPANTS: Older (≥75) ambulatory care participants in ACOVE-2 who screened positive for UI (n=133) or falls or fear of falling (n=328).

MEASUREMENTS: Composite quality scores (percentage of quality indicators (QIs) passed per participant) and change in Incontinence Quality of Life (IQOL, range 0–100) or Falls Efficacy Scale (FES, range 10–40) scores were measured before and after care was delivered (mean 10 months). Because the treatment-related falls QIs were measured only on patients who received a physical examination, an alternative Common Pathway QI (CPQI) score was developed that assigned a failing score for falls treatment to unexamined participants.

RESULTS: Each 10% increment in receipt of recommended care for UI was associated with a 1.4-point improvement in IQOL score (P=.01). The original falls composite quality-of-care score was unrelated to FES, but the new CPQI scoring method for falls quality of care was related to FES outcomes (+0.4 points per 10% increment in falls quality, P=.01).

CONCLUSION: Better quality of care for falls and UI was associated with measurable improvement in participant-reported outcomes in less than 1 year. The connection between process and outcome required consideration of the interdependence between diagnosis and treatment in the falls QIs. The link between process and outcome demonstrated for UI and falls underscores the importance of improving care in these areas.

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