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Relationship Between Quality of Care and Functional Decline in Hospitalized Vulnerable Elders

Arora, Vineet M. MD, MA*; Plein, Colleen BA†; Chen, Stuart BA†; Siddique, Juned DrPH‡; Sachs, Greg A. MD§¶; Meltzer, David O. MD, PhD**∥

doi: 10.1097/MLR.0b013e3181a7e3ec
Original Article

Background: Although process of care is a valuable dimension of quality, process-of-care-based quality indicators (POC-QIs) are ideally associated with meaningful patient outcomes. The relationship between POC-QIs for hospitalized older patients and functional decline, a relevant outcome for older patients, is unknown.

Objective: To assess the relationship between POC-QIs for hospitalized elders and functional decline.

Research Design: Observational cohort study.

Subjects: Hospitalized vulnerable elder patients age 65 or older admitted to a general medicine inpatient service from June 1, 2004 to June 1, 2007.

Measures: POC-QIs received by hospitalized patients (measured by Assessing Care of Vulnerable Elders QIs) and functional decline (increased activities of daily living impairments postdischarge).

Results: For 898 vulnerable elder patients, mean adherence to 6 universally applied quality indicators was 57.8%. After adjustment for factors likely associated with functional decline (comorbidity, vulnerability, baseline functional limitation, number of POC-QIs triggered, length of stay, code status, and interaction between frailty and QI adherence), there was no association higher quality of care (using the composite score) and increased risk of functional decline. Patients who received a mobility plan were 1.48 (95% CI: 1.07–2.05; P = 0.017) times more likely to suffer functional decline after discharge. Patients who received an assessment of nutritional status had a lower odds of suffering functional decline after discharge (OR: 0.37, [95% CI: 0.21–0.64; P < 0.001]).

Conclusions: Hospitalized vulnerable elders who receive higher quality of care, as measured by Assessing Care of Vulnerable Elders QIs, are not less likely to suffer decline after discharge.

From the *Department of Medicine, Section of General Medicine, University of Chicago, Chicago, Illinois; †Pritzker School of Medicine, University of Chicago, Chicago, Illinois; ‡Department of Health Studies, University of Chicago, Chicago, Illinois; §Indiana University Center for Aging Research, Regenstrief Institute Inc, Indianapolis, Indiana; ¶Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University, Indianapolis, Indiana; ∥Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois; and **Department of Economics and Public Policy Studies, University of Chicago, Chicago, Illinois.

This study was funded by the Hartford Health Outcomes Geriatrics Research Scholars Award, National Institute for General Medical Sciences, Donald W. Reynolds Foundation, the University of Chicago's John A. Hartford Foundation Center of Excellence in Geriatrics, and Pritzker Summer Research Program. The funding sources had no role in this study.

Reprints: Vineet Arora, MD, MA, Department of Medicine, Section of General Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2007, AMB W216, Chicago, IL 60637. E-mail: varora@medicine.bsd.uchicago.edu.

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© 2009 Lippincott Williams & Wilkins, Inc.