Quality Indicators - ACOVE 3

Introduction to Quality Indicators – ACOVE 3

The "vulnerable elderly" are those older adults who are at highest risk for serious declines in health and function. This group uses a disproportionate share of health care resources and is most susceptible to the effects of poor quality care. Nonetheless, until the year 2000, objective measures to evaluate their care were lacking. The Assessing Care of Vulnerable Elders (ACOVE) project developed a short questionnaire to identify non-institutionalized vulnerable elders. They then selected 22 clinical conditions prevalent among the elderly for quality measurement and developed an evidence-based set of more than two hundred quality-of-care process indicators to evaluate the care provided to vulnerable elders.

In late 2007, in the third phase of the project, these indicators were reviewed and updated, with the addition of 5 new conditions: COPD, colorectal cancer, breast cancer, sleep disorders, and benign prostatic hypertrophy.

ACOVE 3:

Contains 392 quality indicators,
Covers 26 different conditions,
Includes 14 different types of care processes (e.g., taking a medical history or performing a physical exam),
Covers all four domains of care:
- Screening and prevention (31% of QIs),
- DIagnosis (20%),
- Treatment (35%),
- Follow-up and continuity (14%)

The ACOVE-3 measurement set can be used to evaluate the care provided to vulnerable older persons at the level of the health system, health plan or medical group. These quality indicators can be applied to identify areas of care in need of improvement and can form the basis of interventions to improve care. ACOVE-3 quality indicators are linked to the supporting scientific evidence so that physicians can compare these processes to their own care patterns, inform their understanding of the current state of the medical literature concerning the care of vulnerable older patients, and enhance their practice.

An overview of phase 3 of the project as well as a listing of the ACOVE investigators and the members of the ACOVE advisory committees can be found in the Journal of the American Geriatric Society (October 2007; Vol. 55, No. S2, Supplement pp s247-s487). The methodology used to develop the quality-of-care indicators is described in the Annals supplement. The indicators are grouped within the context of the 26 clinical conditions. Most of the information needed to assess care quality can be obtained from patients' medical records, and the remainder can be obtained from interviews and administrative records (see the ACOVE Quality Indicators Applicable to Medical Records and Administrative Data) (PDF file). The supporting evidence for each of the 26 sets of quality indicators is summarized in a series of articles that appears in the JAGS supplement. Additional articles describe the process of updating the indicators and discuss how to apply the indicators to patients with advanced dementia or otherwise poor prognosis so as to minimize unnecessary discomfort or potentially futile effort. These articles are available below. Additional articles describe the process of updating the indicators and discuss how to apply the indicators to patients with advanced dementia or otherwise poor prognosis so as to minimize unnecessary discomfort or potentially futile effort. These articles are available below.

ACOVE 3 Original Articles

Special Supplement to the Journal of the American Geriatrics Society

View the Table of Contents for the entire list of original articles related to this release of ACOVE 3 Quality Indicators. JAGS October 2007 - Vol. 55 Issue s2 Page S247-S487.