Abstract
There's limited information available about measuring the quality of medical care that is targeted to the needs of older patients. And there's very limited pressure on the system to provide high quality geriatric care. Why is that? Because the quality measures haven't been adequately developed and implemented, and it's more difficult to measure care for an older sample. Measuring care for ill older adults is complex, because they tend to have multiple medical conditions, and they demonstrate substantial variation in goals for care (Wenger and colleagues 2007). The Assessing Care of Vulnerable Elders (ACOVE) project began in 1998 as a collaboration between RAND Health and Pzizer Inc to develop and apply quality indicators (QIs) for assessment and treatment targeted at vulnerable older persons. The project involved defining and identifying the target population, identifying health conditions that cover much of the medical care provided to this population, developing quality-of-care indicators to measure how well those conditions are being addressed, and applying those indicators to determine the actual quality of care received by older adults.
Highlights
There’s limited information available about measuring the quality of medical care that is targeted to the needs of older patients
Let us start with a hypothetical patient, whom we will revisit later in this brief: a 79-year-old woman with osteoporosis, osteoarthritis, type 2 diabetes, hypertension, and chronic obstructive pulmonary disease (COPD), all moderately severe
To apply these QIs, we collected medical records and we looked for patients who were eligible for these quality indicators to see whether they received the recommended care processes
Summary
There’s limited information available about measuring the quality of medical care that is targeted to the needs of older patients. The group measured 24 specific processes of care in treating these six conditions They include aspirin, beta blockers, and smoking cessation counseling after AMI; two treatments for heart failure; flu and pneumococcal immunizations; a mammogram every two years for women aged 52-69; and monitoring blood sugar, cholesterol, and vision for patients with diabetes. These are all important conditions for older people. They’re not the only things that older people need to be concerned about; they’re not the majority of the conditions that contribute to the decline in function of older individuals These measures don’t include consideration of cognitive impairment or difficulty with mobility. They do not answer the questions: Does this older person function OK? Is medical care positively affecting the function of this older person?
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