Quality of Care Delivered Before vs After a Quality-Improvement Intervention for Acute Geriatric Trauma - 22/04/15
, Henry Cryer, MD, PhD, FACS c, Chiao-Li Chan, MSW a, Carol Roth, RN, MPH d, Areti Tillou, MD, MSEd, FACS cAbstract |
Background |
Older trauma-injury patients had improved recovery after we implemented routine geriatric consultation for patients aged 65 years and older admitted to the trauma service of a Level I academic trauma center. The intervention aimed to improve quality of geriatric care. However, the specific care processes that improved are unknown.
Study Design |
We conducted a prospective observation comparing medical care after (December 2007 to November 2009) vs before (December 2006 to November 2007) implementation of the geriatric consult-based intervention. To measure quality of care (QOC), we used 33 previously validated care-process quality indicators (QIs) from the Assessing the Care of Vulnerable Elders (ACOVE) study, measured by review of medical records for 76 geriatric consult (GC) vs 71 control group patients. As prespecified subgroup analyses, we aggregated QIs by type: geriatric (eg, delirium screening) vs nongeriatric condition–based care (eg, thrombosis prophylaxis) and compared QI scores by type of care. Last, we aggregated QI scores into overall, geriatric, and nongeriatric QOC scores for each patient (number of QIs passed/number of QIs eligible), and compared patient-level QOC for the GC vs control group, adjusting for age, sex, ethnicity, comorbidity, and injury severity.
Results |
Sixty-three percent of the GC patients vs 11% of the control group patients received a geriatric consultation. We evaluated 2,505 QIs overall (1,664 geriatric type and 841 nongeriatric QIs). In general, fewer geriatric-type QIs were passed than nongeriatric QIs (71% vs 81%; p < 0.001). We provided better overall QOC to the GC (77%) than control group patients (73%; p < 0.05). However, the difference was not statistically significant after multivariable adjustment (p = 0.08). We improved geriatric QOC for the GC (74%) compared with the control group (68%; p < 0.01), a difference that was significant after multivariable adjustment (p = 0.01).
Conclusions |
Geriatricians and surgeons can collaboratively improve geriatric QOC for older trauma patients.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : GC, ISS, QI, QOC
Plan
| Disclosure Information: Nothing to disclose. |
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| Support: This research was supported by the National Institutes of Aging Claude D Pepper Older American Independence Centers at the University of Michigan (Min 2010–2012; AG 024824 PI Halter) and UCLA (AG001004; Min 2006–2010, Tillou 2008–2010) and the Hartford Foundation Centers of Excellence at UCLA (Min 2007–2009) and University of Michigan (Min 2011–2014). |
Vol 220 - N° 5
P. 820-830 - mai 2015 Retour au numéro
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