DTIC ADA426670: Developing Quality of Care Indicators for the Vulnerable Elderly: The ACOVE Project

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by  Defense Technical Information Center

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GANDY HEALTH

Developing Quality of Care Indicators
for the Vulnerable Elderly

The ACOVE Project

rae people ste surviving ol age
thats se ary time in oat binoey: Mal

cal atesratons eam we pert
paige: many ofthe health pr sais
ually asx tel ith old age. Further
more, che gl a cali ce fr Oe led
lus progressed beyond st vv mexiizing
snahoy of Bis, yo ce ae hes bea pd
tn gh mera qualey aac care eat older
cpl eesive Ta fc, exoing menoree of
patty of eal satus atc often appropiate
forthe ers
RAND Hrsth bt cllabosted with Pres,
nc. wena che fn qulin-abca sees
ston for olde persone, The goals af he
eg Cave of Wala rable Elders {ACOVE)
Pevice rere 10 define the pation eral
neable ede, deny importa swede
cunts thar afce eis gos. lene ase
of ove elie indiana of aly of cae

for this ppubton, and design tra tases
pal of ce the health sets ee

Previous Measures of Guuality of Core
in the Elderly Focused an Only o Few
Gonditions Appropriate to Ehlers

In the pat, measeces of wily of eae in he
rhkalyfowused aly on spe flier a

key Findings:

* litle ean bas sn df he
ally of Real cara tha erable
elders ond ater le ahs ei.

ND hes developed ast fink
"o measure he quay of cara tseived for
diners ha allo ada edu

1 Thao can bod ast
hath heals plore are delivering care
thot ects minim standards for quay,

spec of cate cage oy a mall prn=
portion of thesysvim of ier ae. Such
Jocusedaporoache may tor presen a fap
une of eral qui, ehenene broader epsom
of quaayeticare evaluation ay exchade qusl-
iy Holcaons for agpece of cate shat are

Impose othe well-being af ld its
Quality wf eane may be mote dif
smut fr ole alts than for younger
people Fs, ler ale chon bic
‘aan fa peerers for eae, Por exasigs
older aéule do no exe pede ese de
prolongs parila ishar eave acces at

‘This Highlight summariacs RAND Health reseerch reportd in the flowing publicions:

oaLstSapp tN

Ie sad w abe ACAI rete, Abe

Caner pejer nero tar deeaging he reno al he dence pw the

(gue nero Be ol Ls oie

senza Celle of PyeisistAnanan Savy fs

1 es mba,

coverage pinta. pose erence appanage ets tps

ee
fhe expense cf camion. Sceand, ean ill okler aus cannor
sdrocece for themselves and may bars no fnily mambots

be fies to do w on cheis Behalf. The ACOVE pre
sndeavored to consider the heceroaeucsy and exci. nseds
nF hepa ation in designing «compres se oF ule

ap noceymene tos,

Identifying Vulnerable Edors
‘We dened vulnerable elders as shese persons 65 yeas of
age and alder wo as a high ik for death er Fanci
decline and devised «se of cra on ideaify inst of
thar group for measurement, We secladed the ace of uel
tion dices seleccion exer bec slecring individuals
soley sre nwo che healeh eae they have eeoived

sight nf 42 import aspen of ee populeion—
tae whi ace underinanel wulerdingnoned Tn adrian,
Iesed legit nays we Medes Chicent
enoiny Surrey. we derma rat selFeaed funeconal
tara war a more Impotany peas of amen ell
sand desc Caan ave specie inks! contra, ie dso
a brie telephone survey harasses ag, laud health
lication ia phvsal capable, and Zunctoaal eitain
Individuals who were identified as vulnerable on cbesuesey
swore more chan four times as lke ele or expat
Fintona] devtine aera two-year period a hate who exe

not 0 enn. According 0 cheve sei, 32 peacene of
4 var enallyreperseratse ample of elder wae Seine as
salir

Developing and Implementing the Quality-of Care
Indleators

‘To develop the sytem, 9 national panel of geatcs
idence she medical condicions prevalent aro. aldo!
scl thareomeibyte woe eabidins imocalir, and

Tu onl delves tha ell be measured: and for which
Hletive et neo ceagmene or prevention ae availabe
{Uaing ae cot-t,ne alury eommite cose 22 rap,
incluing dices gules. physegicaliapairmets,
aint cine sates, fo onal ai ol-caelicators
ould he devsloped uy pylon ens, “ACOWE
apie". Accerding to nachna, suns;

fhe eleseed conditions renged ian AD pest 30 pce
amar conmunige-dwellng oder adults,

Tor ach conditioa, che RAND team devel ugg
ofa indices, Qualisy of cate can be messored usirg
richer processes of care oF encores af ae, We chose 10 uss
process measures because process area mere efiiemt mes-
sue af quale of care and are araenable co diet change
Hlowree,toscacns heaven cane processes ord oncom

athe pasalve

have ee suppurel hy high ual reseazch in only fee

ACOVE Topics

Apgnoprute Une of Medici
Chri Pan

Cemivaty oid Ceondnaton of Care
Demene

Depression

Diabetes tlie

ade

Falls endl bly Plane
Hecring ass
Heer Fire
Hosnite! Core

Hypetanan

omic Heo ineone
Sideoarhii

Odeopevoet

Posumania

Prete eee

Preveive Cate

Ske an Abia ti aon :
naar Inaninance

“Fi Inpsionant i

ios ail sove sues wen eel cuba eer
As wredeselopel our pality ic atons, on lini eapens
nea the valle coktears fe We applicable
se chiens

‘Asser of posnal quali indicators wo derslopes Fe cash
‘the 22 epice wing esting uldslines a
These indicanes css Fur danas nares

> Preveneon
= Diagnosis .
= Teeasment
+ Fallow-np

‘Oueteam perforred soustured iteatuce reviews
sexs cheesilence soppotting ink hecren each of he
rrenosed care procetes andl improved cursory in oer
What Dees a Quality Indicator Look Like?
‘Quality Indicolar 1 for Dementia:

Cognitive and Functional Screening

IFe-olzohl elders adrian 9 hosp or et
a physician praca, THEN mmlidnensionl exsecnen
af cogntve ably ard asses af rior sn
aheale oe sucu wanted BECALSE seoaing lor demonic
cas leed eee datseton ond oon of tecimer the
rray dloyfuthorproa:2isen

sods, The proposed quai falcons and the saying
eercace were cevisied by idk auch weap ns
im gesintc cate dad che modi poss tha, wlio oseoed
shee vali and sali sing sitio> wes RADE
UCLA Approptincoses
re racatse dhe appropsianse of nasal eas Bas om
the panel’ erings, we dewle ped aac of 26 yoy aon
or covering che 12 rplce ce hon, “Wh Lean a sly
The qualgy indicasns aces by
the parte ace othe snpaotting

ve evelying gues

Indietor Hook Tl

Terthur evabueel iy the Americ College of Piysciane=
Avwctcw So-s o lneenlfelicine Aang Task Force
If: seq nar

he ACOWE yealigy inate elec ce concer a!

ae
‘any of the indicts ease reamstr ot intoema
tion bor

strc pation yepuleenry ey ae ingended 0 se.

the plover see patient the patient's
prow others focus on deeting el acai woniins hat
sre wnderdtecrd in che elds

lemme, depesion, an. aseienl impeincrs. Fuh:

ond jo ucla

so celine ewan are considera such ae
sdvanus ean psig sn infomned sonsent co eeacmene.
“Tv ieplemnas the pig lies in eae sexing
dovaloped Sestuineais wn abaraer ciel ey nner
‘iow parous or posi, and valuateadrcnicace dat,
oe esing of set of theists sce implored fe 80
managed case plans La soph he pe
ofthe vulnerdle csr, we eosin szeral Ese at,
sight mitigate she decion to apply» patil slcnor
vevMle rare af parin’ar pion, lls facto shades
piven preferences ce cwoidbospaliation or supers and
saws such as alvanceé dementia or documented

‘ecrinal peognosis ich aighe lad prota tn ill
serne otherwise indice slmens of co). la adit

‘when implenensng che idicuev,evaiactoe cnasidel

aod reousces ave Zo

When the Indicarora Can and Cannot Be Used

fae aloo

WL ince ayn i the
fia yung seasmene syste specially desgued Suche
sane of il oder als, Howere, mast note 69 !aipar
sau Feature shout she ACOVE indicat.

Fw. the indicator ate a pactce guidlines. Prctee

giles set efine opm or dea eaten the count
Alvovahy devsienabig Te sons, quali indicators
set wail saved for aceaprile cane—srandarde sat
iPr ae gst ena eat the care of pone qui.
ACOVE indiasos are designed on evans
lash wre at ee ese for plan vel, noe he indica
lev. this cums sha sey canner be used 29 3

dus. physicians, Bureherare, che indicate
oF paiems ro ensure bois
ili fo evaaing hw cane of gm icvidns: pinto: the

Fs esta with aire ue

ets of a sng clon, Racer, the indicators
sear alles us eet she swell are delivereé co ales
able elders by thsi Bal can plat ms

fal groups ard
‘hus could e used 1a ei ese lv uel of rower,

Whar New?
RAND reeurchers have now implementa the AUOYE

le
sre mas

Fda tase the quai of ae ceed by ea
aus whe heat houne xn are eniled in oF

aged cate organiations gla te Tied Sone, The
researchers assed he quay est Bet hth yeitecaod

ual of
hacmacelogical sate—presrtbing aleatins—for vloer
tle eles, 4 Felon up reseasch highligh, aca uf
Gane OlewrAduls Receive” reviews die Bindings,

il wiedica condiinse, Nl sos wos

Sunray ACOVE i a second ples. ACW
le enprove Fe mee] cate physicians provide to oleh
adul by desea al

mg incerescons eo incsase

porfimance ou selvtelepalty disor, Tae

adiarss

respond ia gets cane pronnses chat wee che et
ell aie wu the ually seers pha, The gl of
ACOVE2 fetn devsoqy sales fr changing cial prac
tice shar be abi un spel pei li
cra of RANE Heo ine ad ofc an rae burl a RANO Heh oh in atone The
AND Cayorcon na sont cah cnariatan peting to oman ac rsa rs tp ln ne

Ph ean etd Ho we RAND tr dk miles ces pra MDE jad em,

re 9 dh