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Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care.

ABSTRACT: To identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes.Observational cohort study.Pooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs.Older adults receiving ambulatory care (N=1,015).To prioritize and reduce the QIs into subsets, an expert panel rated each of 69 ambulatory care QIs for the strength of the link between process and benefit, defined as direct trial evidence on older adults or high expectation of benefit if a trial were conducted in older adults. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE Quality for Survival (AQS)-17), five QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms (AQQ-16). Whether AQS-17 would predict 3-year survival was first tested in 1,015 pooled ACOVE-1 and ACOVE-2 participants. Second, whether AQF-5 (n=74) and AQQ-16 (n=359) would predict change in the Physical Component Summary (PCS) score of the Medical Outcomes Study 12-item Short-Form Survey at 1 year was tested in the ACOVE-2 cohort. Control variables were age, function-based vulnerability, and comorbidity.Each 20-percentage-point increment in AQS-17 was associated with survival (hazard ratio (HR)=0.83, P=.01) up to 500 days but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS score (1.13-points per 20%-point increment in AQF-5, P=.02).Subsets of care processes can be linked with outcomes important to older adults. The AQS-17 and AQF-5 are potential tools for improving ambulatory care of older adults.

SUBMITTER: Min L

PROVIDER: S-EPMC4137322 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care.

Min Lillian L Reuben David D Karlamangla Arun A Naeim Arash A Prenovost Katherine K Lee Pearl P Wenger Neil N

Journal of the American Geriatrics Society 20140715 8

<h4>Objectives</h4>To identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes.<h4>Design</h4>Observational cohort study.<h4>Setting</h4>Pooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs.<h4>Participants</h4>Older adults receiving ambulatory care (N= ...[more]

PMID: 25041473

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Project description:BACKGROUND:An increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population. OBJECTIVE:To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations. METHODS:A two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60-69% for moderate consensus as measured on a 5-point Likert type scale. RESULTS:Twenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient's preferences. CONCLUSIONS:The selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.

Dataset Information

Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care.

Publications

Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care.

Similar Datasets

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