Relationship Between Quality of Care of Hospitalized Vulnerable Elders and Postdischarge Mortality

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2010.03024.x Byline: Vineet M. Arora (*[dagger]), Melissa Fish ([dagger]), Anirban Basu ([double dagger]), Jared Olson (s.), Colleen Plein ([dagger]), Kalpana Suresh ([double dagger]), Greg Sachs ([parallel]), David O. Meltzer ([double dagger]#) Keywords: vulnerable elder; quality measures; mortality 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[+ or -]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. Author Affiliation: (*)General Medicine ([double dagger])Hospital Medicine, Department of Medicine ([dagger])Pritzker School of Medicine (#)Department of Economics, Harris School of Public Policy Studies, University of Chicago, Chicago, Illinois (s.)Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington ([parallel])Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana. Article note: Address correspondence to Vineet Arora, University of Chicago, 5841 S. Maryland Ave., MC 2007, AMB W216, Chicago, IL 60637. E-mail: varora@medicine.bsd.uchicago.edu