The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients

Published in: Annals of Internal Medicine, v. 139, no. 9, Nov. 4, 2003, p. 740-747, E748-E759

Posted on RAND.org on January 01, 2003

by Neil S. Wenger, David Solomon, Carol P. Roth, Catherine MacLean, Debra Saliba, Caren Kamberg, Laurence Rubenstein, Roy Young, Elizabeth M. Sloss, Rachel Louie, John L. Adams, John T. Chang, Patricia J. Venus, John Schnelle, Paul G. Shekelle

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BACKGROUND: Many people 65 years of age and older are at risk for functional decline and death. However, the resource-intensive medical care provided to this group has received little evaluation. Previous studies have focused on general medical conditions aimed at prolonging life, not on geriatric issues important for quality of life. OBJECTIVE: To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators (QIs). DESIGN: Observational cohort study. SETTING: Managed care organizations in the northeastern and southwestern United States. PATIENTS: Vulnerable older patients identified by a brief interview from a random sample of community-dwelling adults 65 years of age or older who were enrolled in 2 managed care organizations and received care between July 1998 and July 1999. MEASUREMENTS: Percentage of 207 QIs passed, overall and for 22 target conditions; by domain of care (prevention, diagnosis, treatment, and follow-up); and by general medical condition (for example, diabetes and heart failure) or geriatric condition (for example, falls and incontinence). RESULTS: Patients were eligible for 10 711 QIs, of which 55% were passed. There was no overall difference between managed care organizations. Wide variation in adherence was found among conditions, ranging from 9% for end-of-life care to 82% for stroke care. More treatment QIs were completed (81%) compared with other domains (follow-up, 63%; diagnosis, 46%; and prevention, 43%). Adherence to QIs was lower for geriatric conditions than for general medical conditions (31% vs. 52%; P < 0.001). CONCLUSIONS: Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.

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