Lillian Min1, Henry Cryer2, Chiao-Li Chan3, Carol Roth4, Areti Tillou2. 1. University of Michigan Medical School, Ann Arbor, MI; Geriatric Research Education and Clinical Center (GRECC), VA Health Care Systems, Ann Arbor, MI. Electronic address: lmin@med.umich.edu. 2. Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA. 3. University of Michigan Medical School, Ann Arbor, MI. 4. RAND Health, Santa Monica, CA.
Abstract
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. Published by Elsevier Inc.
BACKGROUND: Older trauma-injurypatients 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 traumapatients. Published by Elsevier Inc.
Authors: Lillian C Min; David B Reuben; Catherine H MacLean; Paul G Shekelle; David H Solomon; Takahiro Higashi; John T Chang; Carol P Roth; Caren J Kamberg; John Adams; Roy T Young; Neil S Wenger Journal: J Am Geriatr Soc Date: 2005-10 Impact factor: 5.562
Authors: Anne M Walling; Steven M Asch; Karl A Lorenz; Jennifer Malin; Carol P Roth; Tod Barry; Neil S Wenger Journal: Support Care Cancer Date: 2012-04-29 Impact factor: 3.603
Authors: William F Fallon; Erin Rader; Stephen Zyzanski; Charlene Mancuso; Berni Martin; Linda Breedlove; Peter DeGolia; Kyle Allen; James Campbell Journal: J Trauma Date: 2006-11
Authors: Camilla L Wong; Raghda AlAtia; Amanda McFarlan; Holly Y Lee; Christina Valiaveettil; Barbara Haas Journal: Can J Surg Date: 2016-10-01 Impact factor: 2.089
Authors: Robert A Tessler; Melissa M Rangel; Micaela L Rosser; Frederick P Rivara; Eileen Bulger; Monica S Vavilala; May J Reed; Saman Arbabi Journal: J Trauma Acute Care Surg Date: 2019-05 Impact factor: 3.313
Authors: Camilla L Wong; Raghda Al Atia; Amanda McFarlan; Holly Y Lee; Christina Valiaveettil; Barbara Haas Journal: Can J Surg Date: 2016-10-01 Impact factor: 2.089