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New Supplement to Annals of Internal Medicine

Standards Proposed to Improve Care for Frail Elderly

PHILADELPHIA -- (October 16, 2001) A supplement to the October 16, 2001, issue of Annals of Internal Medicine explores quality indicators for 22 common conditions that affect the health care of vulnerable older adults. Papers address continuity of care, hospital care and pain management, as well as prevention, screening, diagnosis and management of conditions such as dementia, depression, hearing impairment and arthritis.

The papers come from the Assessing Care of Vulnerable Elders (ACOVE) project of the RAND corporation. The frail or vulnerable elderly, defined as those with more than four times the risk for death or functional decline over a two-year period, are estimated to be between 21 and 32 percent of Americans over age 65. They are the largest consumers of health care.

"If physicians throughout the United States follow these suggestions, the health status of geriatric patients would improve substantially," said James R. Webster, Jr., MD, chairman of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Task Force on Aging. The Task Force reviewed and refined 236 quality indicators for the conditions.

"Quality indicators are not guidelines," said Vincenza Snow, MD, senior medical associate at the American College of Physicians-American Society of Internal Medicine. Snow coordinated the ACP-ASIM review of the project.

"Quality indicators set a minimum standard that, if not met, almost certainly identifies poor-quality care, while practice guidelines try to define optimal care in the context of complex medical decision making," said Snow.

The ACOVE quality indicators are intended to measure -- and improve -- care at the health system or plan level, not to rate performance of individual physicians, said Neil S. Wenger, MD, of RAND. "No individual physician could be responsible for performing all of the processes indicated across all the ACOVE indicators."

"Taking care of vulnerable older adults with multiple chronic conditions is not a one-person job," said Christopher M. Callahan, MD, in an accompanying editorial. "The ACOVE project provides health care systems with an excellent place to start in their quest for measuring the impact of innovations in the systems of care for older adults." The RAND project's Policy Advisory Committee included representatives of major health care plans, insurers, advocacy groups and geriatricians.

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