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Is Patient-Perceived Severity of a Geriatric Condition Related to Better Quality of Care?

Min, Lillian C. MD, MSHS*; Reuben, David B. MD; Keeler, Emmett PhD; Ganz, David A. MD, PhD‡¶; Fung, Constance H. MD, MSHS; Shekelle, Paul MD, PhD‡§¶; Roth, Carol P. RN, MPH§; Wenger, Neil S. MD‡§

doi: 10.1097/MLR.0b013e3181f53523
Brief Report

Background: Care for falls and urinary incontinence (UI) among older patients is inadequate. One possible explanation is that physicians provide less recommended care to patients who are not as concerned about their falls and UI.

Objective: To test whether patient-reported severity for 2 geriatric conditions, falls, and UI, is associated with quality of care.

Research Design: Prospective cohort study of elders with falls and/or fear of falling (n = 384) and UI (n = 163).

Subjects: Participants in the Assessing Care of Vulnerable Elders-2 Study (2002–2003), which evaluated an intervention to improve the care for falls and UI among older (age, ≥75) ambulatory care patients with falls/fear of falling or UI.

Measures: Falls Efficacy Scale (FES) and the Incontinence Quality of Life surveys measured at baseline, quality of care measured by a 13-month medical record abstraction.

Results: There was a small difference in falls quality scores across the range of FES, with greater patient-perceived falls severity associated with better odds of passing falls quality indicators (OR: 1.11 [95% CI: 1.02–1.21] per 10-point increment in FES). Greater patient-perceived UI severity (Incontinence Quality of Life score) was not associated with better quality of UI care.

Conclusions: Although older persons with greater patient-perceived falls severity receive modestly better quality of care, those with more distressing incontinence do not. For both conditions, however, even the most symptomatic patients received less than half of recommended care. Low patient-perceived severity of condition is not the basis of poor care for falls and UI.

From the *Department of Medicine, Division of Geriatrics, University of Michigan Medical School, Ann Arbor, MI; †Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles, CA; ‡General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA; §RAND Health, Santa Monica, CA; and ¶Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA.

Dr. Min is supported by the AHRQ (R21 HS017621). Dr. Min was on the UCLA faculty during the writing of this manuscript, supported by NIA-UCLA (K12 AG001004). Dr. Ganz is funded by the U.S. Department of Veterans Affairs, Veterans Health Administration, VA Health Services Research & Development (HSR&D) Service through the VA Greater Los Angeles HSR&D Center of Excellence (Project # VA CD2 08–012–1). This research was also supported by the UCLA Claude Pepper Older Americans Independence Center funded by the National Institute of Aging (AG028748).

Reprints: Lillian Min, MD, MSHS, Division of Geriatrics, University of Michigan School of Medicine, 300 North Ingalls Building, Wing E, Room 966, Ann Arbor, MI 48109. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.