Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality

Abstract

Objectives: To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors.

Design: Observational cohort study.

Setting: Single academic medical center.

Participants: Patients aged 65 and older who were identified as "vulnerable" using the Vulnerable Elder Survey (VES-13).

Measurements: Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index.

Results: One thousand eight hundred fifty-six inpatient vulnerable older adults were enrolled. Mean quality-of-care score was 59.5 ± 19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES-13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87-1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1-year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68-1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40-0.93; P=.02).

Conclusion: Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.

Figure 1

Patient Recruitment to and Exclusion From Study. *VES-13, 13-item Vulnerable Elders Survey †ICU, Intensive Care Unit

Figure 2

Cox proportional hazards regression model of survival of patients above and below median quality score. † *Adjusted for race, gender, age, marital status, VES-13 score, DNR/DNI status, Charlson comorbidity score, number of quality indicators triggered, length of hospital stay, and number of baseline ADL limitations †Quality score calculated as percent of quality indicators triggered that were actually met