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Byline: Alok Kapoor, MD, MSc (Hospital Medicine Unit, Section of General Internal Medicine, Boston University, Boston, Massachusetts, alok.kapoor@BMC.org); Boris Kader, PhD (Section of General Internal Medicine, Boston University, Boston, Massachusetts, [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2005.01.047 Byline: Ann M. Borzecki (a)(b), Susan A. Oliveria (c)(d)(e), Dan R. Berlowitz (a)(b) Author Affiliation: (a) Center for Health Quality, Outcomes, and Economic Research, Bedford Veterans Affairs Hospital, Bedford, Mass (b) Department of Health Services, Boston University School of Public Health, Boston, Mass (c) The Epigroup, Galt Associates, Inc, Sterling, Va (d) Department of Public Health, Weill Medical College of Cornell University, New York, NY (e) Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY Article History: Received 25 January 2005; Accepted 25 January 2005

This article identifies and discusses key conceptual issues in designing and implementing pay-for-quality programs. Such programs offer financial incentives to providers for achieving predefined quality targets. The purpose of the [...]

Background. Information on the health status of centenarians provides a means for understanding the health care needs of this growing population. Therefore, we examined the health status of a national cohort of centenarian veteran enrollees. Methods. Ninety-three centenarian veteran enrollees returned a complete health history questionnaire, which included questions about sociodemographic information, age-associated conditions, health behaviors, health-related quality of life as measured by the Veterans SF-36, and change in health status. Results. Centenarian veteran enrollees are a group with major impairment across multiple dimensions of health-related quality of life despite having a relatively low prevalence of diseases. They had considerable physical limitations as reflected by their physical health summary scores (26.2 [+ or -] 8.3). However, their mental health was comparatively good (mental health summary score 44.1 [+ or -] 12.5). Compared to younger elderly veterans (ages 85-99), centenarians had a lower prevalence of hypertension, angina or myocardial infarction, diabetes, and chronic low back pain (p < .05). Centenarians had significantly worse physical functioning, role physical, vitality, and social functioning scores than did younger elderly veterans. The two groups did not differ in their general health, bodily pain, role emotional, and mental health scores. Centenarians did not perceive much decline in their physical or mental health during the preceding year. Conclusions. Centenarian veteran enrollees are a group with a low number of age-associated diseases and good mental health despite substantial physical limitations. These results support future studies of services directed toward improvement of function as opposed to those focused solely on the treatment of diseases.

Patient safety has become a major public health concern following the publication of the landmark report, To Err Is Human, by the Institute of Medicine in 1999. This report, along with a subsequent report, Crossing the Quality Chasm, recommended the design of a safer health care system by integrating well-established safety methods to avert medical errors. However, neither patient safety report specifically addressed the implications of safety for elderly patients. This article examines those implications by describing the association between aging and medical errors, identifying geriatric syndromes as medical errors, and focusing on six recommendations that will improve the safety of geriatric care. These six recommendations include the detection and reporting of geriatric syndromes, identifying system failures when geriatric syndromes occur, establishing dedicated geriatric units, improving the continuity of care, reducing adverse drug events, and improving geriatric training programs.

Many people with hypertension are not receiving adequate treatment. Researchers evaluated the care received by 800 people with hypertension over a two-year period. About 40% had high blood pressure despite frequent visits to their doctor. Blood pressure dropped in those who received the most intensive treatment but rose in those who received the least intensive treatment. Intensive treatment consisted of increasing the dose of antihypertensive medication or changing to another drug.