A comparison of how generalists and fellowship-trained geriatricians provide "Geriatric" care

被引：33

作者：

Phelan, Elizabeth A. ^{[1
,3
]}

Genshaft, Scott ^{[4
]}

Williams, Barbara ^{[3
]}

LoGerfo, James P. ^{[2
,3
]}

Wagner, Edward H. ^{[3
,5
]}

机构：

[1] Univ Washington, Div Gerontol & Geriatr Med, Dept Med, Sch Publ Hlth & Community Med, Seattle, WA 98195 USA

[2] Univ Washington, Div Gen Med, Dept Med, Sch Publ Hlth & Community Med, Seattle, WA 98195 USA

[3] Univ Washington, Sch Publ Hlth & Community Med, Dept Hlth Serv, Seattle, WA 98195 USA

[4] Case Western Reserve Univ, Sch Med, Cleveland, OH USA

[5] MacColl Inst Healthcare Innovat, Grp Hlth Cooperat, Seattle, WA USA

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2008年 / 56卷 / 10期

关键词：

aged; health services for the aged/standards; physicians; practice patterns; ambulatory care/patterns; fee-for-service plans/standards; health services research; quality of health care; United States;

D O I：

10.1111/j.1532-5415.2008.01942.x

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 [法学]; 0303 [社会学]; 100203 [老年医学];

摘要：

OBJECTIVES: To determine whether outpatient care provided to older patients by fellowship-trained geriatricians is distinguishable from that provided by generalists. DESIGN: Observational study. SETTING: Three primary care clinics of in academic medical center. PARTICIPANTS: Random sample of 140 adults aged 65 and older receiving primary care at one of the clinics. MEASUREMENTS: A medical chart review involving records of 69 patients receiving primary care from a fellowship-trained geriatrician and 71 patients receiving primary care from a generalist (general internal medicine or family practice) was conducted; information pertaining to two practice behaviors relevant to the care of older adults-avoidance of inappropriate prescribing and proactive assessments for geriatric syndromes-was abstracted. RESULTS: Geriatricians scored 17.6 out of a possible 24 points, on average; generalists scored 14.2 (P < .001). Geriatricians scored higher than generalists on prescribing and geriatric syndrome assessments. In a linear regression model adjusting for patient age and number of comorbidities and clustering according to provider, provider specialty was strongly associated with overall score (beta coefficient for specialty = 6.75, P < .001; 95% confidence interval = 4.57-8.94). CONCLUSION: The practice style of fellowship-trained geriatricians caring for older adults appears to differ from that of generalists with regard to prescribing behavior and assessment for geriatric syndromes.

引用

页码：1807 / 1811

页数：5

共 21 条

[1]

Explicit criteria for determining potentially inappropriate medication use by the elderly - An update [J].

Beers, MH .

ARCHIVES OF INTERNAL MEDICINE, 1997, 157 (14) :1531-1536

[2]

The quality of medical care provided to vulnerable older patients with chronic pain [J].

Chodosh, J ;

Solomon, DH ;

Roth, CP ;

Chang, JT ;

MacLean, CH ;

Ferrell, BA ;

Shekelle, PG ;

Wenger, NS .

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2004, 52 (05) :756-761

[3]

Quality of osteoarthritis care for community-dwelling older adults [J].

Ganz, DA ;

Chang, JT ;

Roth, CP ;

Guan, N ;

Kamberg, CJ ;

Niu, F ;

Reuben, DB ;

Shekelle, PG ;

Wenger, NS ;

Maclean, CH .

ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH, 2006, 55 (02) :241-247

[4]

Gnansounou DR, 2004, T NONFERR METAL SOC, V14, P1

[5]

Quality of care is associated with survival in vulnerable older patients [J].

Higashi, T ;

Shekelle, PG ;

Adams, JL ;

Kamberg, CJ ;

Roth, CP ;

Solomon, DH ;

Reuben, DB ;

Chiang, L ;

MacLean, CH ;

Chang, JT ;

Young, RT ;

Saliba, DM ;

Wenger, NS .

ANNALS OF INTERNAL MEDICINE, 2005, 143 (04) :274-281

[6]

The quality of pharmacologic care for vulnerable older patients [J].

Higashi, T ;

Shekelle, PG ;

Solomon, DH ;

Knight, EL ;

Roth, C ;

Chang, JT ;

Kamberg, CJ ;

MaClean, CH ;

Young, RT ;

Adams, J ;

Reuben, DB ;

Avorn, J ;

Wenger, NS .

ANNALS OF INTERNAL MEDICINE, 2004, 140 (09) :714-720

[7]

Relationship between number of medical conditions and quality of care [J].

Higashi, Takahiro ;

Wenger, Neil S. ;

Adams, John L. ;

Fung, Constance ;

Roland, Martin ;

McGlynn, Elizabeth A. ;

Reeves, David ;

Asch, Steven M. ;

Kerr, Eve A. ;

Shekelle, Paul G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (24) :2496-2504

[8]

Institute of Medicine (U.S.). Committee on the Future Health Care Workforce for Older Americans, 2008, RET AG AM BUILD HLTH

[9]

Change in the quality of care delivered to Medicare beneficiaries, 1998-1999 to 2000-2001 [J].

Jencks, SF ;

Huff, ED ;

Cuerdon, T .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (03) :305-312

[10]

Quality of medical care delivered to Medicare beneficiaries - A profile at state and national levels [J].

Jencks, SF ;

Cuerdon, T ;

Burwen, DR ;

Fleming, B ;

Houck, PM ;

Kussmaul, AE ;

Nilasena, DS ;

Ordin, DL ;

Arday, DR .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 284 (13) :1670-1676

← 1 2 3 →