Evaluation of a guided protocol for quality improvement in identifying common geriatric problems

OBJECTIVES: Many common geriatric problems are underrecognized and undertreated. A simple and reliable tool to facilitate a standard approach to evaluating geriatric patients might improve the quality of medical care delivered to geriatric patients. The objective of this study was to evaluate a standardized, semistructured quality-improvement protocol (the guided geriatric care protocol) for the assessment of common geriatric problems. DESIGN: Sequential comparison cohorts, with chart review to evaluate study measures before and after introduction of the guided geriatric care protocol. SETTING: The outpatient consultative geriatric assessment center of Yale-New Haven Hospital in New Haven, Connecticut. PARTICIPANTS: One hundred consecutive new patients before and 100 consecutive new patients after introduction of the guided geriatric care protocol. MEASUREMENTS: Number and type of problems identified and recommendations made during the clinical encounter, duration of the clinical encounter, clinician acceptance. RESULTS: The two patient groups were similar in socio-demographics, cognitive and functional status, and reasons for evaluation. Significantly more problems were identified after (mean 5.51) than before (mean 3.49) introduction of the guided geriatric care protocol (P <.001); likewise, significantly more recommendations were made after (mean 10.45) than before (mean 8.48) introduction of the protocol (P <.001). The duration of the clinical encounter did not differ significantly between the two groups. The protocol was well accepted by participating clinicians. CONCLUSIONS: Use of the guided geriatric care protocol assured a standard approach to evaluating common geriatric problems and may have led to the identification and treatment of more problems than usual care without increasing the duration of the clinical encounter. A quality-improvement tool that standardizes the evaluation of common geriatric problems, if validated in other clinical settings, holds the potential to improve the quality of care for vulnerable older patients.