Does Better Quality of Care for Falls and Urinary Incontinence Result in Better Participant-Reported Outcomes?
Published in: Journal of the American Geriatrics Society, v. 59, no.8, Aug. 2011, p. 1435-1443
Posted on RAND.org on August 01, 2011
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.