Improving Quality of Health Care for Older Adults

In 2000, RAND Health Care researchers released the first set of quality measures specifically developed for the vulnerable elderly—those most likely to die or become severely disabled in the next two years (see chart Who Are the Vulnerable Elderly? in Research Brief 9051). The Assessing Care of Vulnerable Elderly (ACOVE) indicators reflect the most comprehensive examination ever conducted of the quality of medical care provided to vulnerable older Americans (see chart What Does a Quality Indicator Look Like? in Research Brief 9051).

The Assessing Care of Vulnerable Elders (ACOVE) quality indicator measurement set responds to the dearth of measurement tools aimed at the medical care received by older patients. While there has been an explosion in attention to quality and quality measurement over the past decade, few measures focused on the particular care needs of older persons, who use a disproportionate amount of medical care and are particularly susceptible to the adverse effects of substandard care. Measuring medical care for ill older patients is complex because they tend to have multiple medical conditions and they demonstrate substantial variation in preferences. Thus, ACOVE measures aim to comprehensively evaluate the medical care provided to older persons with illness living in the community who are at increased risk of decline.

The ACOVE measures, which reflect a combination of clinical evidence and expert opinion, were used to assess the care being provided to elderly people by primary care physicians in several large health care systems nationwide. In phase 2 of the ACOVE study (ACOVE-2), the researchers used the results of these assessments, and the measures themselves, to evaluate several practical interventions in primary care practices aimed at improving performance of some of the most underperformed health care procedures, as identified in ACOVE-1.

To reflect progress in diagnosis and treatment and to create a more comprehensive set of quality measures, the ACOVE team produced a new set of indicators. ACOVE-3 updates and expands the ACOVE measurement set to better reflect the range of health care problems of the vulnerable elderly, the team added 5 new conditions—COPD, colorectal cancer, breast cancer, sleep disorders, and benign prostatic hypertrophy