• J Am Geriatr Soc · Aug 2014

    Observational Study

    Abbreviated care-process quality indicator sets linked with survival and functional status benefit in older adults under ambulatory care.

    • Lillian Min, David Reuben, Arun Karlamangla, Arash Naeim, Katherine Prenovost, Pearl Lee, and Neil Wenger.
    • Division of Geriatric and Palliative Medicine, Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan; Geriatrics Research, Education and Clinical Care Center, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan.
    • J Am Geriatr Soc. 2014 Aug 1;62(8):1442-50.

    ObjectivesTo identify subsets of ambulatory care (outpatient only) quality indicators (QIs) associated with better survival and physical function outcomes.DesignObservational cohort study.SettingPooled data from the Assessing Care of Vulnerable Elders (ACOVE)-1 study, which measured quality of care using 140 care-process QIs, and the subsequent ACOVE-2 study, which reduced the QIs to 69 ambulatory care QIs.ParticipantsOlder adults receiving ambulatory care (N=1,015).MeasurementsTo prioritize and reduce the QIs into subsets, an expert panel rated each of 69 ambulatory care QIs for the strength of the link between process and benefit, defined as direct trial evidence on older adults or high expectation of benefit if a trial were conducted in older adults. This resulted in three reduced QI sets, reflecting their intended benefit: 17 QIs for survival (ACOVE Quality for Survival (AQS)-17), five QIs to preserve function (AQF-5), and 16 QIs to improve quality-of-life related to physical health and symptoms (AQQ-16). Whether AQS-17 would predict 3-year survival was first tested in 1,015 pooled ACOVE-1 and ACOVE-2 participants. Second, whether AQF-5 (n=74) and AQQ-16 (n=359) would predict change in the Physical Component Summary (PCS) score of the Medical Outcomes Study 12-item Short-Form Survey at 1 year was tested in the ACOVE-2 cohort. Control variables were age, function-based vulnerability, and comorbidity.ResultsEach 20-percentage-point increment in AQS-17 was associated with survival (hazard ratio (HR)=0.83, P=.01) up to 500 days but not thereafter. AQF-5, but not AQQ-16, predicted 1-year improvement in PCS score (1.13-points per 20%-point increment in AQF-5, P=.02).ConclusionSubsets of care processes can be linked with outcomes important to older adults. The AQS-17 and AQF-5 are potential tools for improving ambulatory care of older adults.© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

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