The quality of medical care provided to vulnerable community-dwelling older patients

被引:302
作者
Wenger, NS
Solomon, DH
Roth, CP
MacLean, CH
Saliba, D
Kamberg, CJ
Rubenstein, LZ
Young, RT
Sloss, EM
Louie, R
Adams, J
Chang, JT
Venus, PJ
Schnelle, JF
Shekelle, PG
机构
[1] RAND Corp, Hlth, Santa Monica, CA 90407 USA
[2] RAND Corp, Hlth, Washington, DC USA
[3] Univ Calif Los Angeles, Sch Med, Los Angeles, CA USA
[4] Greater Los Angeles Vet Affairs Healthcare Syst, Los Angeles, CA USA
[5] Los Angeles Jewish Home Aging, Los Angeles, CA USA
[6] Borun Ctr Gerontol Res, Los Angeles, CA USA
[7] United Healthcare Corp, Ctr Hlth Care Policy & Evaluat, Minnetonka, MN USA
关键词
D O I
10.7326/0003-4819-139-9-200311040-00008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Many people 65 years of age and older are at risk for functional decline and death. However, the resource-intensive medical care provided to this group has received little evaluation. Previous studies have focused on general medical conditions aimed at prolonging life, not on geriatric issues important for quality of life. Objective: To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators (Qls). Design: Observational cohort study. Setting: Managed care organizations in the northeastern and southwestern United States. Patients: Vulnerable older patients identified by a brief interview from a random sample of community-dwelling adults 65 years of age or older who were enrolled in 2 managed care organizations and received care between July 1998 and July 1999. Measurements: Percentage of 207 Qls passed, overall and for 22 target conditions; by domain of care (prevention, diagnosis, treatment, and follow-up); and by general medical condition (for example, diabetes and heart failure) or geriatric condition (for example, falls and incontinence). Results: Patients were eligible for 10 711 Qls, of which 55% were passed. There was no overall difference between managed care organizations. Wide variation in adherence was found among conditions, ranging from 9% for end-of-life care to 82% for stroke care. More treatment Qls were completed (81%) compared with other domains (follow-up, 63%; diagnosis, 46%; and prevention, 43%). Adherence to Qls was lower for geriatric conditions than for general medical conditions (31% vs. 52%; P < 0.001). Conclusions: Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.
引用
收藏
页码:740 / 747
页数:8
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