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Contrasting Effects of Geriatric Versus General Medical Multimorbidity on Quality of Ambulatory Care
Author(s) -
Min Lillian,
Kerr Eve A.,
Blaum Caroline S.,
Reuben David,
Cigolle Christine,
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.12989
Subject(s) - medicine , ambulatory , multimorbidity , geriatric care , geriatrics , ambulatory care , medical care , gerontology , family medicine , nursing , health care , psychiatry , chronic disease , economics , economic growth
Objectives To determine whether greater burden of geriatric conditions would have contrasting effects on quality of care ( QOC ) than nongeriatric, general medical conditions. Design Cross‐sectional observation over 1 year of ambulatory care. Setting The A ssessing C are of V ulnerable E lders‐2 study. Participants Older adults prospectively screened for falls, incontinence, and dementia (N = 644). Measurements Participant‐level QOC in absolute percentage points calculated using 65 ambulatory care care‐process quality indicators ( QI s) for 13 general medical and geriatric conditions (# QI s provided/# QI s eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QI s) and medical QOC (the 27 remaining nongeriatric QI s). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site. Results Medical and geriatric comorbidity were unrelated to each other (correlation coefficient = 0.04, P = .27) yet had opposite effects on QOC . Each additional medical condition was associated with a 3.2‐percentage point (95% confidence interval ( CI ) = 2.3–4.2 percentage point) increment in QOC , and each additional geriatric condition was associated with 4.9‐percentage point (95% CI = 3.5–6.5 percentage point) decrement in QOC . Participants with greater geriatric comorbidity received poorer medical and geriatric QOC . Conclusion Greater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC . Geriatric multimorbidity should be targeted for better care using a comprehensive approach.