Quality of care provided in a special needs plan using a nurse care manager model.

Objectives: To comprehensively evaluate the quality of care provided in special needs plans (SNPs; Medicare Advantage plans that aim to provide specialized care for complex older adults) and specifically the nurse care management model in the community setting.

Design: We adapted 107 process-of-care quality measures across 12 conditions from the Assessing Care of Vulnerable Elders set to obtain a clinically detailed evaluation of the quality of care received by complex older enrollees in a dual eligible Evercare SNP. We abstracted 13 months of primary care medical records to delineate quality of care provided by physicians and whether there was value added from the nurse care manager model.

The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients.

Objectives: To test the predictive properties of the Vulnerable Elders-13 Survey (VES-13) a short tool that predicts functional decline and mortality over a 1- to 2-year follow-up interval over a 5-year interval.

Design: Longitudinal evaluation with mean follow-up of 4.5 years.

A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia.

Objectives: To determine whether a practice-based intervention can improve care for falls, urinary incontinence, and cognitive impairment.

Design: Controlled trial.

Setting: Two community medical groups.

Multimorbidity is associated with better quality of care among vulnerable elders.

Background: Older patients with multiple chronic conditions may be at higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions. Possible reasons include competing guidelines for individual conditions, burden of numerous recommendations, and difficulty implementing treatments for multiple conditions.

Objectives: We sought to determine whether coexisting combinations of 8 common chronic conditions (hypertension, coronary artery disease, chronic obstructive pulmonary disease, osteoarthritis, diabetes mellitus, depression, osteoporosis, and having atrial fibrillation or congestive heart failure) are associated with overall quality of care among vulnerable older patients.

The effect of a quality improvement initiative on the quality of other aspects of health care: the law of unintended consequences?

Problem: Policymakers and clinicians are concerned that initiatives to improve the quality of care for some conditions may have unintended negative consequences for quality in other conditions.

Objective: We sought to determine whether a practice redesign intervention that improved care for falls, incontinence, and cognitive impairment by an absolute 15% change also affected quality of care for masked conditions (conditions not targeted by the intervention).

Design, Setting, And Participants: Controlled trial in 2 community medical groups, with 357 intervention and 287 control patients age 75 years or older who had difficulty with falls, incontinence, or cognitive impairment.