Abstract
BackgroundThe number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).MethodsThe methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.ResultsThree quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.ConclusionContent validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.
Highlights
The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research
University affiliated Geriatric Evaluation and Management Units (GEMUs) are staffed by full-time certified internist-geriatricians whereas the majority of GEMUs are run by family physicians who divide their busy office practice with part-time spent in GEMU
Falls in the elderly are of interest in and by themselves, our purpose is to judge the overall quality of care delivered to frail elderly by GEMUs based on falls as a tracer condition
Summary
The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). Between 1978 and 1999, Geriatric Evaluation and Management Units (GEMUs) were established as specialized inpatient programs in most acute care hospitals in the province of Québec, Canada. Previous work has shown these units to be highly heterogeneous in terms of their structure, in the training and experience of the health care professionals, the characteristics of the patients treated, the procedures for admission, and the functions they serve [2]. The heterogeneity among GEMU structures might reflect adaptation to contextual and environmental demands. There is concern if the heterogeneity adversely influences the process of care and compromises health care outcomes
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