OBJECTIVES: To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors. DESIGN: Observational cohort study. SETTING: Single academic medical center. PARTICIPANTS: Patients aged 65 and older who were identified as "vulnerable" using the Vulnerable Elder Survey (VES-13). MEASUREMENTS: Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index. RESULTS: One thousand eight hundred fifty-six inpatient vulnerable older adults were enrolled. Mean quality-of-care score was 59.5 ± 19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES-13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87-1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1-year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68-1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40-0.93; P=.02). CONCLUSION: Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.
OBJECTIVES: To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors. DESIGN: Observational cohort study. SETTING: Single academic medical center. PARTICIPANTS: Patients aged 65 and older who were identified as "vulnerable" using the Vulnerable Elder Survey (VES-13). MEASUREMENTS: Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index. RESULTS: One thousand eight hundred fifty-six inpatient vulnerable older adults were enrolled. Mean quality-of-care score was 59.5 ± 19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES-13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87-1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1-year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68-1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40-0.93; P=.02). CONCLUSION: Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.
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