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

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Far more people are surviving to old age than at any time in our history. Medical interventions can now prevent or postpone many of the health problems traditionally associated with old age. Furthermore, the goal of medical care for the elderly has progressed beyond survival to maximizing quality of life, yet little attention has been paid to the overall quality of medical care that older people receive. In fact, existing measures of quality or health status are often inappropriate for the elderly. RAND Health has collaborated with Pfizer, Inc. to create the first quality-of-care assessment system for older persons. The goals of the Assessing Care of Vulnerable Elders ACOVE project were to define the population of vulnerable elderly, identify important medical conditions that affect this group, develop a set of evidence-based indicators of quality of care for this population, and design a tool to assess quality of care at the health system level. To develop the system, a national panel of geriatrics experts identified the medical conditions prevalent among older adults that contribute most to morbidity, mortality, and functional decline that could be measured and for which effective methods of treatment or prevention are available. Using these criteria, the advisory committee chose 22 topics, including diseases, syndromes, physiological impairments, and clinical situations, for which quality-of-care indicators could be developed. For each topic, the RAND team developed quality-of-care indicators that could be measured using processes of care. The expert panel assessed the evidence supporting links between each care process and improved outcomes in older adults, which resulted in 236 ACOVE quality indicators. These indicators can be used to assess whether health plans are delivering care that meets minimum standards for quality.

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  • Medicine and Medical Research
  • Test Facilities, Equipment and Methods

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