The quality of medical care provided to vulnerable community-dwelling older patients
The quality of medical care provided to vulnerable community-dwelling older patients
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DOI：
10.7326/0003-4819-139-9-200311040-00008
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发表时间：
2003-11-04
影响因子：
39.2
通讯作者：
Shekelle, PG
中科院分区：
文献类型：
--
作者：
Wenger, NS;Solomon, DH;Shekelle, PG
背景：许多65岁及以上的人有功能下降和死亡的风险。然而，向这一群体提供的资源密集型医疗保健却很少得到评价。以前的研究集中在一般的医疗条件，旨在延长生命，而不是对老年人的问题重要的生活quality.Objective：To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators（Qls）.Design：Observational cohort study.Setting：Managed care organizations in the Northeast and Southwest United States.Patients：脆弱的老年患者通过一个简短的采访确定从一个随机抽样的社区居住的成年人65岁或以上谁参加了2个管理式护理组织和1998年7月和1999年7月之间接受护理。测量：207个QLS通过的百分比，总体和22个目标条件;按护理领域（预防、诊断、治疗和随访）和一般医疗状况（例如，糖尿病和心力衰竭）或老年病状况（例如，福尔斯和失禁）。管理式医疗机构之间没有总体差异。在不同的条件下，依从性差异很大，从9%的临终关怀到82%的中风护理。与其他领域（随访，63%;诊断，46%;和预防，43%）相比，完成了更多的治疗Ql（81%）。老年条件下的QLS依从性低于一般医疗条件（31%对52%; P < 0.001）。结论：对弱势老年人的护理福尔斯缺乏各种条件下的可接受水平。对老年人的护理远不如对一般医疗状况的护理那么理想。
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.Objective: To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators (Qls).Design: Observational cohort study.Setting: Managed care organizations in the northeastern and southwestern United States.Patients: Vulnerable older patients identified by a brief interview from a random sample of community-dwelling adults 65 years of age or older who were enrolled in 2 managed care organizations and received care between July 1998 and July 1999.Measurements: Percentage of 207 Qls passed, overall and for 22 target conditions; by domain of care (prevention, diagnosis, treatment, and follow-up); and by general medical condition (for example, diabetes and heart failure) or geriatric condition (for example, falls and incontinence).Results: Patients were eligible for 10 711 Qls, of which 55% were passed. There was no overall difference between managed care organizations. Wide variation in adherence was found among conditions, ranging from 9% for end-of-life care to 82% for stroke care. More treatment Qls were completed (81%) compared with other domains (follow-up, 63%; diagnosis, 46%; and prevention, 43%). Adherence to Qls was lower for geriatric conditions than for general medical conditions (31% vs. 52%; P < 0.001).Conclusions: Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.