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Abbreviated Care‐Process Quality Indicator Sets Linked with Survival and Functional Status Benefit in Older Adults Under Ambulatory Care
Author(s) -
Min Lillian,
Reuben David,
Karlamangla Arun,
Naeim Arash,
Prenovost Katherine,
Lee Pearl,
Wenger Neil
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12943
Subject(s) - medicine , ambulatory , observational study , hazard ratio , ambulatory care , cohort , quality of life (healthcare) , health care , cohort study , comorbidity , emergency medicine , gerontology , confidence interval , nursing , economics , economic growth
Objectives To identify subsets of ambulatory care (outpatient only) quality indicators ( QI s) associated with better survival and physical function outcomes. Design Observational cohort study. Setting Pooled data from the Assessing Care of Vulnerable Elders ( ACOVE )‐1 study, which measured quality of care using 140 care‐process QI s, and the subsequent ACOVE ‐2 study, which reduced the QI s to 69 ambulatory care QI s. Participants Older adults receiving ambulatory care (N = 1,015). Measurements To prioritize and reduce the QI s into subsets, an expert panel rated each of 69 ambulatory care QI s 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 QI s for survival ( ACOVE Quality for Survival ( AQS )‐17), five QI s to preserve function ( AQF ‐5), and 16 QI s 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. Results Each 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). Conclusion Subsets 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.