Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality

Vineet M. Arora, Melissa Fish, Anirban Basu, Jared Olson, Colleen Plein, Kalpana Suresh, Greg Sachs, David O. Meltzer

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1642-1648
Number of pages7
JournalJournal of the American Geriatrics Society
Volume58
Issue number9
DOIs
StatePublished - 2010

Fingerprint

Quality of Health Care
Mortality
Confidence Intervals
Nutrition Assessment
Social Security
Activities of Daily Living
Nutritional Status
Proportional Hazards Models
Observational Studies
Comorbidity
Inpatients
Length of Stay
Cohort Studies
Logistic Models
Odds Ratio

Keywords

  • mortality
  • quality measures
  • vulnerable elder

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Medicine(all)

Cite this

Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. / Arora, Vineet M.; Fish, Melissa; Basu, Anirban; Olson, Jared; Plein, Colleen; Suresh, Kalpana; Sachs, Greg; Meltzer, David O.

In: Journal of the American Geriatrics Society, Vol. 58, No. 9, 2010, p. 1642-1648.

Research output: Contribution to journalArticle

Arora, Vineet M. ; Fish, Melissa ; Basu, Anirban ; Olson, Jared ; Plein, Colleen ; Suresh, Kalpana ; Sachs, Greg ; Meltzer, David O. / Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality. In: Journal of the American Geriatrics Society. 2010 ; Vol. 58, No. 9. pp. 1642-1648.
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abstract = "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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AU - Fish, Melissa

AU - Basu, Anirban

AU - Olson, Jared

AU - Plein, Colleen

AU - Suresh, Kalpana

AU - Sachs, Greg

AU - Meltzer, David O.

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