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.

Patients' global ratings of their health care are not associated with the technical quality of their care.

Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood.

Objective: To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.

Quality of osteoarthritis care for community-dwelling older adults.

Objective: To describe the quality of osteoarthritis care provided to community-dwelling elderly patients and to characterize arthritis-related function in these patients.

Methods: Two medical groups in the western United States participated in a practice-redesign intervention targeted at falls and mobility disorders, incontinence, and cognitive impairment, but not osteoarthritis. From 339 individuals reporting a diagnosis of arthritis, we collected information on demographics, functional status, and quality of care via patient interviews and mailed questionnaires.

Comparison of administrative data and medical records to measure the quality of medical care provided to vulnerable older patients.

Background: Administrative data are used to determine performance for publicly reported in health plan "report cards," accreditation status, and reimbursement. However, it is unclear how performance based on administrative data and medical records compare.

Methods: We compared applicability, eligibility, and performance on 182 measures of health care quality using medical records and administrative data during a 13-month period for a random sample of 399 vulnerable older patients enrolled in managed care.

Do proxies reflect patients' health concerns about urinary incontinence and gait problems?

Background: While falls and urinary incontinence are prevalent among older patients, who sometimes rely on proxies to provide their health information, the validity of proxy reports of concern about falls and urinary incontinence remains unknown.

Methods: Telephone interviews with 43 consecutive patients with falls or fear of falling and/or bothersome urinary incontinence and their proxies chosen by patients as most knowledgeable about their health. The questionnaire included items derived from the Medical Outcomes Study Short Form 12 (SF-12), a scale assessing concerns about urinary incontinence (UI), and a measure of fear of falling, the Falls Efficacy Scale (FES).

Predictors of overall quality of care provided to vulnerable older people.

Objectives: Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated.

Design: Observational cohort study.

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

Background: Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent patient outcomes is unclear.

Objective: To examine the link between the quality of care that patients received and their survival.

Design: Observational cohort study.

Detection and management of falls and instability in vulnerable elders by community physicians.

Objectives: To investigate quality of care for falls and instability provided to vulnerable elders.

Design: Six process of care quality indicators (QIs) for falls and instability were developed and applied to community-living persons aged 65 and older who were at increased risk of death or decline. QIs were implemented using medical records and patient interviews.

The quality of pharmacologic care for vulnerable older patients.

Background: Although pharmacotherapy is critical to the medical care of older patients, medications can have considerable toxicity in this age group. To date, research has focused on inappropriate prescribing and policy efforts have aimed at access, but no comprehensive measurement of the quality of pharmacologic management using explicit criteria has been performed.

Objective: To evaluate the broad range of pharmacologic care processes for vulnerable older patients.

Reliability of clinical guideline development using mail-only versus in-person expert panels.

Background: Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion.

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

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.