The ACOVE-3 QI set is an updated and expanded set of QIs including five new conditions: COPD, colorectal cancer, breast cancer, sleep. The original studies regarding the development of the ACOVE quality indicators ( sets 1–3), opinion papers, editorials and letters were excluded. Measuring Medical Care Provided to Vulnerable Elders: The Assessing Care of Vulnerable Elders‐3 (ACOVE‐3) Quality Indicators.

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ACOVE-3 contains a set of QIs to comprehensively measure the care provided to vulnerable older persons at the level of the health system, health plan, or medical group. Since evaluating the quality indicators imply laborious data collection activities, future work for care assessment and improvement will be considerably facilitated once the measurement systems are in place. One study by McGory et al. Our results suggest two opportunities for additional work on quality indicator application.

When viewed per condition, there were between 1 and 43 quality indicators used. Although the ACOVE set was developed for vulnerable elderly patients, the majority of the studies did not distinguish between the vulnerable elders and the general elderly population. The studies are described in a thematic conceptual model meant to understand the different ways in which the ACOVE quality indicators have been used and to expose areas of promising future research.

Overall, between 3 and quality indicators were used in the 18 studies. Two studies focused on nursing home residents, seven on community-dwelling patients [ 34363739—42 ], one on hospitalized patients [ 35 ] and two studies avove on patients in primary qcove [ 3845 ]. Three studies assessed the quality of care using only medical records [ 373845 ].

Predictors of successful prompted voiding among incontinent nursing home residents. Our results suggest that the ACOVE framework has mainly been used to assess care, rather than to achieve the ultimate goal of the quality indicators, that of improving the quality of care, although it is possible that such initiatives are not always published.


J Am Geriatr Soc. To get insight into the nature of these studies, we describe the most important findings per category. Twelve studies were classified into this category [ 19263148—56 ]. We foresee an important role for application of indicators that proactively help health-care professionals to deliver the right care at the right time, for example by resorting to decision support systems.

Only seven studies explicitly mentioned that the population consisted of vulnerable elderly patients, all of which used the Vulnerable Elders Survey VES to identify vulnerability.

In this systematic review we identified and summarized 41 relevant research papers pertaining to the ACOVE quality indicators. The first round consisted of critically reading the title, keywords and abstract. In most studies, the combination of patient record review and interviews was used to extract the data.

ACOVEquality indicatorsquality of careelderlyvulnerable eldersclinical decision support systems.

Inter-rater agreement was high kappa: For each condition, a content expert created potential QIs and, based on systematic reviews, developed a peer-reviewed monograph detailing each QI and its supporting evidence. The effects of multimorbidity, polypharmacy and the overall quality of care have been acovve [ 1—5 ].

Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set.

A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. The vulnerable elders, defined as the group of persons 65 years of age or older who are at high risk of death or functional decline, form an important subgroup for investigation [ 9 ].

Only one study in our review addressed the positive association between quality indicator performance and survival among community-dwelling vulnerable older adults. In the cases when the reviewers were unable to reach consensus a third reviewer was involved to make a final decision. The association between quality acoove care and the following factors were studied: First, only one study developed a completely original indicator set that consisted of quality indicators with content not based on ACOVE indicators.

Introduction to the assessing care of vulnerable elders-3 quality indicator measurement set.

Eight articles pertained to the assessment of care for a specific condition: This set consists of explicitly phrased IF—THEN clinical rules with comprehensive coverage of general medical and geriatric conditions.


Two studies used a combination of medical records, direct observation, interviews and electronic measurement [ 43acovr ]. Simply translating and adapting the comprehensive ACOVE quality indicators may prove sufficient in the same patient group. This may be related to the difficulty of developing a new quality indicator set.

Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands.

Predictors of overall quality of care provided to vulnerable older people. Twitter Facebook Linkedin Rss.

No other persons contributed to this project. The authors declare that they have no conflicts of interest.

Twelve studies fell into this category [ 34—45 ]. Assessment is meant to inform acive, in consequence, to facilitate quality improvement efforts [ 916 ].

The final study classified into this category reported the validation, and not the adaptation of a quality indicator set. Receive exclusive offers and updates from Oxford Academic.

Unlike subjective methods, objective methods consist of explicitly specified assessment instruments and are often based on literature review and expert consensus, and acovf therefore more reliable [ 12 ]. Two studies used a different approach: The first study implemented a pharmacotherapist-led educational intervention that consisted of a theoretical presentation and a knowledge test, both based caove 30 pharmacology-related quality indicators [ 46 ].

This category contains two studies. The studies were organized in a conceptual model containing five main categories providing a better understanding of where and how ACOVE quality indicators have been applied since Two studies in this category explicitly mentioned the inclusion of patients aged 50 years or older.

Studies aove shown that elderly patients often do not receive care appropriate to their age and conditions [ 58 ].