Setting Priorities for Measures of Performance for Geriatric Medical Services

University of Southampton, Southampton, England, United Kingdom
Age and Ageing (Impact Factor: 3.64). 04/1994; 23(2):154-7. DOI: 10.1093/ageing/23.2.154
Source: PubMed


We undertook a two-round Delphi study of the views of consultant geriatricians in three Health Regions on the relative appropriateness of 12 possible performance measures for geriatric services. We compared geriatricians' responses with those of 44 cognitively-intact day hospital patients. Of 138 geriatricians, 89 responded to the first round postal survey, 84 to the second round. The rank order of geriatricians' suggestions did not change from round one to round two, and there was convergence of opinion with a significant decrease in the coefficients of variation of the ranks (p < 0.05, Wilcoxon Test). Geriatricians and patients gave high priority to 'reducing disability' and 'improving quality of life', and low priority to 'reducing mortality'. Geriatricians gave higher priority than patients to 'consumer satisfaction', 'problem resolution' and 'efficient use of resources'. Patients gave higher priority to 'reducing burden on carers', 'measures of service activity' and 'avoiding institutional care'. The study shows that it is possible to obtain a consensus amongst geriatricians about the priorities for measuring the performance of geriatric medical services. Similarities to and differences from patients' views illustrate the need to engage more than one group in the debate about appropriate measures of performance. Findings in both groups give support to recent attempts to develop and use assessment methods for the measurement of disability and quality of life in clinical practice.

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    • "Quality of life is regarded as a key healthcare outcome by patients and by clinicians; both groups see improvement in quality of life as an important function of Medicine for Older People services such as Day Hospitals [1]. Most Day Hospital services do not routinely measure quality of life however; the emphasis remains on the measurement of function [2,3], and it is thus difficult to know whether such services are successful in improving quality of life. "
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    ABSTRACT: To test the ease of use, reliability, responsiveness and construct validity of the Patient Generated Index, an individualised quality of life score, in older people attending a Medicine for Older People Day Hospital. Prospective longitudinal study in patients attending a specialist Medicine for Older People Day Hospital in Scotland. The Patient Generated Index was administered at baseline, one week later, and at the end of Day Hospital attendance. Functional Limitations Profile, Hospital Anxiety and Depression Score, Barthel index and global subjective impressions of change were also collected and compared with baseline scores and change in Patient Generated Index scores. Reliability was assessed using intraclass correlation coefficients in subjects reporting no change in global quality of life; responsiveness was assessed using effect size and Guyatt coefficients in subjects reporting change in global quality of life. External validity was assessed via correlation with measures of physical function, comorbid disease and psychological state. 75 patients were enrolled, mean age 81 years. Mean completion time was 5.0 minutes at baseline. Reliability was moderate (intraclass correlation coefficient 0.72) but there were weak and inconsistent responses to change (effect sizes 0.02 to 0.15; Guyatt responsiveness coefficient 0.29). Patient Generated Index scores correlated with Functional Limitation Profile scores (r = 0.51, p < 0.001), baseline anxiety score (r = -0.25, P = 0.039) and baseline depression score (r = -0.37, P = 0.002) but displayed only weak, non-significant correlation with number of comorbid diseases (r = -0.22, P = 0.07), number of medications (r = -0.21, P = 0.08) and Barthel score (r = 0.09, p = 0.45). The Patient Generated Index appears moderately reliable and easy to complete, but is poorly responsive to change, limiting its usefulness in clinical practice or research.
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    ABSTRACT: We sought the views of purchasers and provider managers in the South and West Region on the relative priorities of 15 possible performance measures of a geriatric medical service. Using a postal questionnaire, subjects were asked to rank the measures in order of priority. Improving patients' quality of life was judged the most important measure by all groups except for the purchasing chief executives, who placed it second to improving patients' physical function (which was overall the second most important measure). The lowest priority was given to measurement of levels of activity and reducing mortality rates. Priorities were similar to those found with patients and geriatricians in a previous study, and supports the development and use of performance measures of disability and the quality of life of patients.
    Full-text · Article · Aug 1996 · Age and Ageing
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    ABSTRACT: The aim of the study is to identify criteria that frail elderly patients refer to when they appreciate the quality of care of Geriatric assessment units. Twenty-one patients recently released from six Geriatric assessment units in Montreal participated in face-to-face interviews (n = 17) or in a Focus Group (n = 4). Patients reported 56 different criteria grouped into four main dimensions of quality: the environment of care, the attitude and the technical competence of professionals and the results of care. The environment of care consists of physical resources and person related qualities. Comments on the attitude and the technical competence of professionals related mostly to the nurses and physicians. Some quality criteria reported by elderly patients are similar to those reported by patients in various acute care units while others are specific to the frailty of their condition. This study provides health care professionals with rich and useful information on how elderly patients perceive the quality of various components of care in Geriatric assessment units.
    No preview · Article · Dec 1997 · Canadian Journal on Aging / La Revue canadienne du vieillissement
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