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Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition.

Kergoat MJ, Leclerc BS, Leduc N, Latour J, Berg K, Bolduc A - BMC Geriatr (2009)

Bottom Line: Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified.Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%).Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Centre, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada. marie-jeanne.kergoat@umontreal.ca

ABSTRACT

Background: The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).

Methods: The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002-2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.

Results: Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.

Conclusion: Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.

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Outline of the reviewers' training process and of the measures of reliability of the Geriatric Care Tool. Description of the theoretical and practical training process and of the measurement of intra- and inter-reliability of the Geriatric Care Tool (GCT) during the collection of data. GEMU: Geriatric Evaluation and Management Unit.
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Figure 2: Outline of the reviewers' training process and of the measures of reliability of the Geriatric Care Tool. Description of the theoretical and practical training process and of the measurement of intra- and inter-reliability of the Geriatric Care Tool (GCT) during the collection of data. GEMU: Geriatric Evaluation and Management Unit.

Mentions: The next paragraphs describe the steps involved in the development of the GCT, including its reliability and feasibility, during a retrospective chart review of older inpatients admitted for the tracer condition of a fall-related trauma in GEMUs during the year 2002–2003, which are summarized in Figures 1 and 2.


Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition.

Kergoat MJ, Leclerc BS, Leduc N, Latour J, Berg K, Bolduc A - BMC Geriatr (2009)

Outline of the reviewers' training process and of the measures of reliability of the Geriatric Care Tool. Description of the theoretical and practical training process and of the measurement of intra- and inter-reliability of the Geriatric Care Tool (GCT) during the collection of data. GEMU: Geriatric Evaluation and Management Unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2724372&req=5

Figure 2: Outline of the reviewers' training process and of the measures of reliability of the Geriatric Care Tool. Description of the theoretical and practical training process and of the measurement of intra- and inter-reliability of the Geriatric Care Tool (GCT) during the collection of data. GEMU: Geriatric Evaluation and Management Unit.
Mentions: The next paragraphs describe the steps involved in the development of the GCT, including its reliability and feasibility, during a retrospective chart review of older inpatients admitted for the tracer condition of a fall-related trauma in GEMUs during the year 2002–2003, which are summarized in Figures 1 and 2.

Bottom Line: Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified.Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%).Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Centre, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada. marie-jeanne.kergoat@umontreal.ca

ABSTRACT

Background: The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).

Methods: The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002-2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.

Results: Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.

Conclusion: Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.

Show MeSH
Related in: MedlinePlus