Improving Quality of Care for Elderly Patients in the Educational Setting

American Board of Internal Medicine42 enrolled

Overview

This is a multi-center exploratory study (each site got local IRB approval) of the impact of an educational toolkit combined with a practice-performance self-evaluation instrument (ABIM Care of the Vulnerable Elderly Practice Improvement Module) on trainee knowledge, skills, and attitudes about practice-based learning and improvement and systems-based practice in the care of elderly patients.

This is a longitudinal quasi-experimental study. Programs will be randomly assigned to either the comparison or intervention group, stratified based on program size, affiliation, geographic location, and presence of a geriatrics fellowship program. Faculty will be trained in use of the CoVE PIM and in the development and implementation of a quality improvement plan. Residents in the intervention group will perform the medical record audit portion of the CoVE PIM. Patient surveys will be distributed by the residency clinics. The goal will be to audit the medical records of patients who complete the patient survey. Residents in intervention groups will participate in completing the practice system survey as a group. Finally, the residents in the intervention group will use the data from the medical record audit, patient survey, and practice system survey, working with faculty, to develop a quality improvement project to improve care for their geriatric patients. Local medical record abstractors will be trained to perform a separate medical record audit of a random sample of the same patients identified by the residents for both the intervention and comparison groups. The abstractors will perform both a baseline and follow-up audit and will target the same patients who are still living from the baseline period. The follow-up audit will occur 12 months after completion of the initial PIM data collection phase, or approximately 18 months after the initiation of the study. Evaluation of study outcomes will occur on the program, resident, and patient level.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

SINGLE

Enrollment

Conditions

Elderly

Interventions

ABIM Care of Vulnerable Elderly Practice Improvement ModuleOTHER

The ABIM CoVE PIM is a practice-performance self-evaluation instrument. It is a web-based tool based on nationally recognized guidelines that uses chart abstraction, patient surveys, and a practice system survey in order to generate a performance report focused on a key aspects of care for vulnerable elderly.

Geriatric and Quality Improvement toolkitOTHER

A resource toolkit about geriatrics and quality improvement was given to both study arms.

Eligibility

Sex: ALLMin age: 65 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * All residents at a resident clinic site * Preceptors that are selected by the Champion for a particular resident clinic site * Patients age 65 years or older for whom any of the following measures would be appropriate: falls prevention, identifying urinary incontinence, screening for depression and cognitive impairment, and providing other preventive care. * Patients who have been in the practice for at least one year * Patients who are ambulatory * Patients who have been seen at least once by the practice within the past 12 months. Exclusion Criteria: * Patients under age 65 * Patients who have a terminal illness * Patients with a life expectancy of less than one-year

Outcomes

Primary Outcomes

Practice Improvement Module (PIM) quality impact

Assess the impact of the Care of the Vulnerable Elderly (CoVE) Practice Improvement Module to improve the quality of care received by elderly patients in the residency ambulatory setting.

Time frame: 2 years

Secondary Outcomes

Assess satisfaction

Assess resident and faculty satisfaction with the Care of the Vulnerable Elderly Practice Improvement Module.

Time frame: 2 years

Assess feasibility

Assess the feasibility of conducting surveys of elderly patients in the residency training setting.

Time frame: 2 years

Assess use of geriatric and quality improvement toolkit

Assess the use and impact of an educational toolkit for teaching geriatric quality of care. The analysis will specifically focus on what components of the toolkit are used by programs.

Time frame: 2 years

Assess effects of disparities on elder care

Assess the effects of health disparities on the care of elderly patients in a training setting.

Time frame: 2 years

Assess barriers in training setting

Assess structural barriers to providing quality care for vulnerable elderly in diverse training settings

Time frame: 2 years

Practice Improvement Module impact for knowledge, skills, and attitudes

Assess the impact of the Care of the Vulnerable Elderly Practice Improvement Module to improve the knowledge, skills, and attitudes of residents in the care of specific geriatric conditions.

Data from ClinicalTrials.gov

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