Using assessing care of vulnerable elders quality indicators to measure quality of hospital care for vulnerable elders

J Am Geriatr Soc. 2007 Nov;55(11):1705-11. doi: 10.1111/j.1532-5415.2007.01444.x.


Objectives: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).

Design: Prospective cohort study.

Setting: Single academic medical center.

Participants: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status.

Measurements: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse).

Results: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3-83.7% vs 75.8%, 95% CI=70.5-81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3-83.7 vs 31.4% 95% CI=27.5-35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission.

Conclusion: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chicago
  • Chronic Disease / epidemiology
  • Chronic Disease / therapy*
  • Comorbidity
  • Cross-Sectional Studies
  • Delirium / epidemiology
  • Delirium / therapy
  • Dementia / epidemiology
  • Dementia / therapy
  • Female
  • Frail Elderly*
  • Geriatric Assessment / statistics & numerical data
  • Hospitalization*
  • Hospitals, University
  • Humans
  • Male
  • Mass Screening
  • Pressure Ulcer / epidemiology
  • Pressure Ulcer / therapy
  • Process Assessment, Health Care / statistics & numerical data*
  • Quality Assurance, Health Care / standards*
  • Quality Indicators, Health Care
  • Risk Factors
  • Vulnerable Populations / statistics & numerical data*