ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue

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American Board of Internal Medicine- Measures (1)- This PIM examines the care you provide to your patients by addressing key processes and outcomes of care for older patients. These are based primarily on guidelines from the American Geriatrics Society.
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ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue

  1. 1. ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue
  2. 2. Care of the Vulnerable Elderly PIM Measures Catalogue September 2010 TABLE OF CONTENTS Introduction .............................................................................................................................................................. 3 Processes of Care.................................................................................................................................................... 5 Patient Experience: Outcomes of Care .............................................................................................................. 17 Patient Experience: Processes of Care ............................................................................................................. 18Care of the Vulnerable Elderly Measure Catalog September 2010 Page 2 of 22
  3. 3. IntroductionThis catalogue provides information related to the American Board of Internal Medicine’s Care of the Vulnerable ElderlyPractice Improvement Module®. It is written in language that addresses the physician who might choose to complete thismodule, and it details the specifics of the module. Included is information regarding: • Purpose and structuring of the module • Patient inclusion criteria • Detailed description of the measuresThis PIM examines the care you provide to your patients by addressing key processes and outcomes of care for older patients. Theseare based primarily on guidelines from the American Geriatrics Society.The PIM is divided into three parts, with multiple sections in each part.Part 1 -Performance DataProvide baseline data about your practices current performance by... • Surveying your patients • Reviewing your charts • Assessing your practice systemsThe 17 patient survey measures and 44 chart review measures are summarized below. ABIM requires a minimum of 25 patientsurveys and 25 chart reviews. The practice systems assessment comprises questions covering various aspects of practice structureand protocols.Patients can be included in this module if all of the following are true: 1. They are at least 75 years old. If it is not feasible to identify 50 patients age 75 and older who meet the other inclusion/exclusion criteria, you may include patients age 65 and older; 2. They have been patients in the practice for at least one year; AND 3. They have been seen by the practice within the past 12 months.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 3 of 22
  4. 4. Patients should be excluded from this module if any of the following is true: 1. They are unable to complete the patient survey, even with assistance; 2. They are non-ambulatory; 3. They have severe cognitive impairment; OR 4. They have a terminal illness and life expectancy of less than one year.Part 2 - Quality Improvement (QI) PlanDevelop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysiswill include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this qualityimprovement (QI) cycle.Part 3 - RemeasurementRemeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect onthe process of developing and implementing a QI plan.You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates thiseducational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 4 of 22
  5. 5. CARE OF THE VULNERABLE ELDERLY - PROCESSES OF CAREHistoryMeasure Title Description Numerator Denominator RationaleChronic Medical Conditions Percentage of questions in the Number of questions in the Number of possible Chronic Medical Conditions Chronic Medical Conditions responses to the section of the chart review for section of the chart review for questions in the which "Yes" or "No" responses which "Yes" or "No" responses Chronic Medical were given, indicating that the were given, indicating that the Conditions section necessary information was necessary information was of the chart review available to the physician; available to the physician; questions asked about the questions asked about the presence or absence of presence or absence of diabetes, CHD, heart failure, diabetes, CHD, heart failure, prior CVA, hypertension, prior CVA, hypertension, arthritis that limits mobility or arthritis that limits mobility or causes significant pain, prior hip causes significant pain, prior hip fracture, osteoporosis, fracture, osteoporosis, neuropathy, Parkinsons neuropathy, Parkinsons disease, COPD, cognitive disease, COPD, cognitive impairment, visual impairment, impairment, visual impairment, and hearing impairment and hearing impairment Patients in the sample who Number of patients in the were reported as having sample who were reported as cognitive impairment having cognitive impairmentSmoking status Patients in the sample whose Number of patients in the Number of patients The routine and thorough current smoking status was sample whose current smoking in the sample assessment of tobacco use is documented status was documented important as a means of preventing smoking or encouraging cessation.Alcohol use Patients in the sample whose Number of patients in the Number of patients Elderly persons are at higher risk current level of alcohol use was sample whose current level of in the sample for alcohol-related health documented within the past 12 alcohol use was documented problems. This higher risk is due to months within the past 12 months a lower tolerance to the effects of alcohol; a higher likelihood of using multiple medications; and a higher likelihood of other physical disabilities or frailty, including slowed reaction times, impaired vision, and hearing loss. After drinking equal amounts of alcohol,Care of the Vulnerable Elderly Measure Catalog September 2010 Page 5 of 22
  6. 6. HistoryMeasure Title Description Numerator Denominator Rationale older adults have higher blood alcohol levels than younger adults. Excess use of alcohol by older patients can increase the risk of falls, worsen problems with incontinence, and complicate cognitive impairment. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that people over 65 limit themselves to one drink daily.Level of physical activity Patients in the sample whose Number of patients in the Number of patients Research supports the current level of physical activity sample whose current level of in the sample recommendation that exercise was documented within the past physical activity was (i.e., resistance/strength training; 12 months documented within the past 12 balance, gait, and co-ordination months training) helps to reduce falls.Mobility and functional Percentage of questions in the Number of questions in the Number of possible Mobility and functional statusstatus Mobility and Functional Status Mobility and Functional Status responses to the determine the ability to participate sections of the chart review for sections of the chart review for Mobility and in daily activities, including self- which "Yes" or "No" responses which "Yes" or "No" responses Functional Status care and social interaction. Any were given, indicating that the were given, indicating that the questions in the change in mobility or functional necessary information was necessary information was chart review status should prompt investigation available to the physician; available to the physician; of etiology and consequences. questions asked about the questions asked about the patients mobility status (ability patients mobility status (ability to climb a flight of stairs and to climb a flight of stairs and walk 1/4 mile) and general walk 1/4 mile) and general physical functional status physical functional statusUse of over-the-counter Patients in the sample whose Number of patients in the Number of patients Many older adults use over-the-medications use of over-the-counter sample whose use of over-the- in the sample counter (OTC) medications, but medications was documented counter medications was many patients do not inform their documented physicians about their use. Patients should be asked directly about their use of such medications. OTC drugs may be harmful, of no benefit, or interact with prescribed medications.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 6 of 22
  7. 7. HistoryMeasure Title Description Numerator Denominator RationaleUse of Patients in the sample whose Number of patients in the Number of patients Many older adults usecomplimentary/alternative use of sample whose use of in the sample complementary/alternativemedications complimentary/alternative complimentary/alternative medications (CAM), but many medications was documented medications was documented patients do not inform their physicians about their use. Patients should be asked directly about their use of CAM, which may be harmful, of no benefit, or interact with prescribed medications.Screening and EvaluationMeasure Title Description Numerator Denominator RationaleDepression screen Patients in the sample reported Number of patients in the sample Number of patients Depression is common in olderwithin past 12 months as having had a screen for reported as having had a screen in the sample adults but also is under-recognized depression within the past 12 for depression within the past 12 and under-treated. The risk of months months depression is increased in patients who have other illnesses and/or functional limitations.Cognitive impairment Patients in the sample reported Number of patients in the sample Number of patients A detailed evaluation of cognitivescreen within past 12 as having had a screening test reported as having had a in the sample, function is one element of amonths for cognitive impairment within screening test for cognitive excluding those with multifactorial assessment for fall the past 12 months impairment within the past 12 a diagnosis of risk. months cognitive impairment (for whom screening for cognitive impairment, therefore, is not appropriate)Falls-risk screen within Patients in the sample reported Number of patients in the sample Number of patients All older patients (or theirpast 12 months as having had a screening for reported as having had a in the sample caregivers) should be asked at least falls risk within the past 12 screening for falls risk within the once a year about falls, frequency months past 12 months of falling, and difficulties in gait or balance.Urinary incontinence Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common inscreen reported as having had who were reported as having in the sample older adults, and its prevalenceCare of the Vulnerable Elderly Measure Catalog September 2010 Page 7 of 22
  8. 8. Screening and EvaluationMeasure Title Description Numerator Denominator Rationale screening for urinary had screening for urinary increases with age. Incontinence is incontinence incontinence associated with other common geriatric conditions, including prior hysterectomy, obesity, prior stroke, chronic obstructive pulmonary disease, slow gait speed, and poor overall health. It has a significant negative impact on self-esteem and quality of life; incontinence also is a risk factor for depression, falls, and nursing home placement. Surgical, medical, and behavioral treatments vary with the etiology; while not all patients will be interested in exploring treatment options, all can benefit from advice on managing the condition.Vision testing within Patients in the sample who were Number of patients in the sample Number of patients Aging is associated with changes inpast 24 months - reported as having had a vision who were reported as having in the sample visual acuity, development ofChRvw test within the past 24 months had a vision test within the past cataracts, macular degeneration, 24 months glaucoma, and other conditions.Physical ExaminationMeasure Title Description Numerator Denominator RationaleWeight Patients in the sample with Number of patients in the sample Number of patients Measuring body weight over time is weight documented who have weight documented in the sample a simple screen for nutritional adequacy and change in older adults. Nonvolitional weight loss may be predictive of mortality.Height Patients in the sample with Number of patients in the sample Number of patients Studies have shown that height loss height documented who have height documented in the sample increases the likelihood of osteoporosis of the hip and increases with the amount of height lost.Blood pressure Patients in the sample whose Number of patients in the sample Number of patients The detection and treatment of high blood pressure whose blood pressure in the sample blood pressure can reduce the riskCare of the Vulnerable Elderly Measure Catalog September 2010 Page 8 of 22
  9. 9. Physical ExaminationMeasure Title Description Numerator Denominator Rationale (systolic/diastolic) was measured (systolic/diastolic) was measured of morbidity and mortality from during the specified abstraction coronary heart disease, stroke, and period (within 12 months of the chronic kidney disease. visit date, with a three-month grace period), with date and value of the measurement documentedPostural hypotension Patients in the sample who were Number of patients in the sample Number of patients Postural hypotension has beenassessment within past reported as having had a who were reported as having in the sample associated with an increased risk of12 months postural hypotension had a postural hypotension falls. assessment within the past 12 assessment within the past 12 months monthsGait evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance reported as having had a gait who were reported as having in the sample should be evaluated in older evaluation had a gait evaluation patients, particularly those who have had a fall. This evaluation can serve as a screening tool to identify patients who may need multifactorial fall-risk assessment or as a component of such an assessment.Balance evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance reported as having had a who were reported as having in the sample should be evaluated in older balance evaluation had a balance evaluation patients, particularly those who have had a fall. This evaluation can serve as a screening tool to identify patients who may need multifactorial fall-risk assessment or as a component of such an assessment.Quadriceps strength Patients in the sample who were Number of patients in the sample Number of patients Testing of muscle strength in thetesting reported as having had who were reported as having in the sample lower extremities is one element of quadriceps strength testing had quadriceps strength testing a multifactorial assessment for fall risk.Testing for rigidity Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular(cogwheeling) reported as having had testing who were reported as having in the sample examination is one element of a for rigidity (cogwheeling) had testing for rigidity multifactorial assessment for fallCare of the Vulnerable Elderly Measure Catalog September 2010 Page 9 of 22
  10. 10. Physical ExaminationMeasure Title Description Numerator Denominator Rationale (cogwheeling) risk. Parkinsons disease is associated with an increased risk for falls.Testing for bradykinesia Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular reported as having had testing who were reported as having in the sample examination is one element of a for bradykinesia had testing for bradykinesia multifactorial assessment for fall risk. Parkinsons disease is associated with an increased risk for falls.Assessments and Treatments – Falls, Problems with Walking, BalanceMeasure Title Description Numerator Denominator RationaleCircumstances of fall Patients in the sample who were Number of patients in the sample Number of patients It is important to have a detaileddocumented reported as having fallen within who were reported as having in the sample who description of the circumstances of the past 12 months and for fallen within the past 12 months were reported as falls, including frequency, symptoms whom the circumstances of the and for whom the circumstances having fallen within at the time of the event, injuries, fall were completely documented of the fall were completely the past 12 months and other consequences. documentedGait evaluation done Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance reported as either having fallen who were reported as either in the sample who should be evaluated in older or as having a fear of falling having fallen or as having a fear were reported as patients, particularly those who during the past 12 months and of falling during the past 12 either having fallen have had a fall. This evaluation can for whom a gait evaluation was months and for whom a gait or as having a fear serve as a screening tool to identify done evaluation was done of falling during the patients who may need past 12 months multifactorial fall-risk assessment or as a component of such an assessment.Balance evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balancedone reported as either having fallen who were reported as either in the sample who should be evaluated in older or as having a fear of falling having fallen or as having a fear were reported as patients, particularly those who during the past 12 months and of falling during the past 12 either having fallen have had a fall. This evaluation can for whom a balance evaluation months and for whom a balance or as having a fear serve as a screening tool to identify was done evaluation was done of falling during the patients who may need past 12 months multifactorial fall-risk assessment or as a component of such an assessment.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 10 of 22
  11. 11. Assessments and Treatments – Falls, Problems with Walking, BalanceMeasure Title Description Numerator Denominator RationaleQuadriceps strength Patients in the sample who were Number of patients in the sample Number of patients Testing of muscle strength in thetesting done reported as either having fallen who were reported as either in the sample who lower extremities is one element of or as having a fear of falling having fallen or as having a fear were reported as a multifactorial assessment for fall during the past 12 months and of falling during the past 12 either having fallen risk. for whom quadriceps strength months and for whom or as having a fear testing was done quadriceps strength testing was of falling during the done past 12 monthsTesting for rigidity Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular(cogwheeling) done reported as either having fallen who were reported as either in the sample who examination is one element of a or as having a fear of falling having fallen or as having a fear were reported as multifactorial assessment for fall during the past 12 months and of falling during the past 12 either having fallen risk. Parkinsons disease is for whom testing for rigidity months and for whom testing for or as having a fear associated with an increased risk (cogwheeling) was done rigidity (cogwheeling) was done of falling during the for falls. past 12 monthsTesting for bradykinesia Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromusculardone reported as either having fallen who were reported as either in the sample who examination is one element of a or as having a fear of falling having fallen or as having a fear were reported as multifactorial assessment for fall during the past 12 months and of falling during the past 12 either having fallen risk. Parkinsons disease is for whom testing for bradykinesia months and for whom testing for or as having a fear associated with an increased risk was done bradykinesia was done of falling during the for falls. past 12 monthsPhysical Patients in the sample who were Number of patients in the sample Number of patients Physical therapy interventions,therapy/rehabilitation reported as either having fallen who were reported as either in the sample who including gait training, progressivereferral made or as having a fear of falling having fallen or as having a fear were reported as balance exercises, and home during the past 12 months and of falling during the past 12 either having fallen evaluation for environmental for whom a referral for physical months and for whom a referral or as having a fear hazards, may be indicated for therapy or rehabilitation was for physical therapy or of falling during the patients who have a history of, or at made rehabilitation was made past 12 months risk for, falls. Assistive devices also may be useful for some patients.Medication review done Patients in the sample who were Number of patients in the sample Number of patients Medications are an important and reported as either having fallen who were reported as either in the sample who modifiable risk factor for falls. or as having a fear of falling having fallen or as having a fear were reported as Several drugs that act upon the during the past 12 months and of falling during the past 12 either having fallen central nervous system have been for whom a medication review months and for whom a or as having a fear associated with increased fall risk, was done, addressing an medication review was done, of falling during the including antidepressants, important and reversible risk addressing an important and past 12 months benzodiazepines, neuroleptics, and factor for falls reversible risk factor for falls antiepileptics. Vasodilators also areCare of the Vulnerable Elderly Measure Catalog September 2010 Page 11 of 22
  12. 12. Assessments and Treatments – Falls, Problems with Walking, BalanceMeasure Title Description Numerator Denominator Rationale linked with increased fall risk. A recent change in the dosage of a medication and the total number of medications prescribed also appear to increase the risk of falling.Home-safety Patients in the sample who were Number of patients in the sample Number of patients Home-safety questionnaires canassessment done reported as either having fallen who were reported as either in the sample who help patients and their caregivers or as having a fear of falling having fallen or as having a fear were reported as identify risks for falls within the during the past 12 months and of falling during the past 12 either having fallen home. If safety issues are identified for whom a home safety months and for whom a home- or as having a fear that cannot be readily addressed by assessment was done or safety assessment was done or of falling during the the patient, consider referring the arranged arranged past 12 months patient to the local Area Agency on Aging.Assessments and Treatments – Urinary IncontinenceMeasure Title Description Numerator Denominator RationaleUrinary incontinence Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common inbothersome enough to reported as having urinary who were reported as having in the sample who older adults, and its prevalenceask about treatment incontinence and for whom the urinary incontinence and for were reported as increases with age. Incontinence is condition was bothersome whom the condition was having urinary associated with other common enough for the patient to ask bothersome enough for the incontinence geriatric conditions, including prior about treatment options patient to ask about treatment hysterectomy, obesity, prior stroke, options chronic obstructive pulmonary disease, slow gait speed, and poor overall health. It has a significant negative impact on self-esteem and quality of life; incontinence also is a risk factor for depression, falls, and nursing home placement. Surgical, medical, and behavioral treatments vary with the etiology; while not all patients will be interested in exploring treatment options, all can benefit from advice on managing the condition.Evaluation/treatment for Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common inbothersome urinary reported as having bothersome who were reported as having in the sample who older adults, and its prevalenceCare of the Vulnerable Elderly Measure Catalog September 2010 Page 12 of 22
  13. 13. Assessments and Treatments – Urinary IncontinenceMeasure Title Description Numerator Denominator Rationaleincontinence - ChRvw urine leakage and who received bothersome urine leakage and were reported as increases with age. Incontinence is evaluation or treatment for it who received evaluation or having bothersome associated with other common treatment for it urine leakage geriatric conditions, including prior hysterectomy, obesity, prior stroke, chronic obstructive pulmonary disease, slow gait speed, and poor overall health. It has a significant negative impact on self-esteem and quality of life; incontinence also is a risk factor for depression, falls, and nursing home placement. Surgical, medical, and behavioral treatments vary with the etiology; while not all patients will be interested in exploring treatment options, all can benefit from advice on managing the condition.Preventive CareMeasure Title Description Numerator Denominator RationaleInfluenza vaccine during Patients in the sample Number of patients in the Number of patients in Influenza is a common, preventablethe most recent flu season who were reported as sample who were the sample infectious disease associated with high having received influenza reported as having mortality and morbidity in the elderly and in vaccine during the most received influenza vaccine people with chronic diseases. recent flu season during the most recent flu seasonPneumococcal vaccine Patients in the sample Number of patients in the Number of patients in Pneumonia is a common, preventable who were reported as sample who were the sample infectious disease associated with high having received reported as having mortality and morbidity in the elderly and in pneumococcal vaccine received pneumococcal people with chronic diseases. vaccineZoster vaccine Patients in the sample Number of patients in the Number of patients in Herpes zoster infection is common in older who were reported as sample who were the sample adults, as is the complication of having received zoster reported as having postherpetic neuralgia. Vaccination is vaccine received zoster vaccine recommended for all adults age 65 and older, regardless of their history of prior zoster infection.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 13 of 22
  14. 14. Preventive CareMeasure Title Description Numerator Denominator RationaleBone-mineral density Female patients in the Number of female patients Number of female Bone mineral density correlates with bonescreening for women sample who have in the sample who have patients in the sample strength and is an excellent predictor of received bone-density received bone-density future fracture risk. The National screening screening Osteoporosis Foundation recommends screening for women age 65 and older, regardless of other risk factors.Bone-mineral density Male patients age 70 and Number of male patients Number of male patients Bone mineral density correlates with bonescreening for men age 70 older in the sample who age 70 and older in the age 70 and older in the strength and is an excellent predictor ofand older have received bone- sample who have sample future fracture risk. The National density screening received bone-density Osteoporosis Foundation recommends screening screening for men age 70 and older, regardless of other risk factors.Home-safety checklist Patients in the sample Number of patients in the Number of patients in Home-safety questionnaires can help who were reported as sample who were reported the sample patients and their caregivers identify risks having received a home- as having received a for falls within the home. safety checklist home-safety checklistAdvice to limit alcohol Patients in the sample Number of patients in the Number of patients in Elderly persons are at higher risk forconsumption who were reported to sample who were the sample reported to alcohol-related health problems. This engage in potentially reported to engage in engage in excessive higher risk is due to a lower tolerance to the hazardous drinking and potentially hazardous alcohol consumption effects of alcohol; a higher likelihood of who have been advised to drinking and who have using multiple medications; and a higher limit their alcohol been advised to limit their likelihood of other physical disabilities or consumption alcohol consumption frailty, including slowed reaction times, impaired vision, and hearing loss. After drinking equal amounts of alcohol, older adults have higher blood alcohol levels than younger adults. Excess use of alcohol by older patients can increase the risk of falls, worsen problems with incontinence, and complicate cognitive impairment. Excess use of alcohol by older patients can increase the risk of falls, worsen problems with incontinence, and complicate cognitive impairment. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that people over 65 limit themselves to one drink daily.Advice to start, increase, Patients in the sample Number of patients in the Number of patients in Research supports the recommendationCare of the Vulnerable Elderly Measure Catalog September 2010 Page 14 of 22
  15. 15. Preventive CareMeasure Title Description Numerator Denominator Rationaleor maintain exercise who were advised to start, sample who were advised the sample that exercise (i.e., resistance/strengthprogram - ChRvw increase, or maintain to start, increase, or training; balance, gait, and co-ordination participation in an maintain participation in training) helps to reduce falls. exercise program that an exercise program that includes attention to includes attention to balance and strength balance and strengthSmoking-cessation Current smokers in the Number of current Number of current A number of large randomized clinical trialscounseling sample documented to smokers in the sample smokers in the sample have demonstrated the efficacy and cost- have received smoking- documented to have effectiveness of smoking-cessation cessation counseling received smoking- counseling in changing smoking behavior during the 12-month cessation counseling and reducing tobacco use. period prior to the index during the 12-month visit, with a three-month period prior to the index grace period visit, with a three-month grace periodEnd-of-Life-CareMeasure Title Description Numerator Denominator RationalePatients preferences Patients in the sample whose Number of patients in the sample Number of patients Physicians routinely should discussfor life-sustaining care preferences for life-sustaining whose preferences for life- in the sample life-sustaining treatment decisionsare documented care were documented sustaining care were with their patients, particularly documented before the actual need for such care arises. Patients should be asked to designate a surrogate decision maker and to discuss their preferences with this person and with other family members and friends.Patients designated Patients in the sample whose Number of patients in the sample Number of patients Physicians routinely should discusssurrogate decision designated surrogate decision whose designated surrogate in the sample life-sustaining treatment decisionsmaker is documented maker was documented decision maker was documented with their patients, particularly before the actual need for such care arises. Patients should be asked to designate a surrogate decision maker and to discuss their preferences with this person and with other family members and friends.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 15 of 22
  16. 16. Other AssessmentsMeasure Title Description Numerator Denominator RationaleHearing assessment Patients in the sample Number of patients in the Number of patients in Hearing loss is associated with depression who were reported as sample who were the sample and decreased quality of life; it also can be having had a hearing reported as having had a mistaken for confusion or poor cooperation assessment within the hearing assessment in older adults. past 12 months within the past 12 monthsCare of the Vulnerable Elderly Measure Catalog September 2010 Page 16 of 22
  17. 17. PATIENT EXPERIENCE: CARE OF THE VULNERABLE ELDERLY – OUTCOMES OF CAREPatient SatisfactionMeasure Title Description Numerator Denominator RationalePatient rates care of Patients in the sample who Number of patients in the sample Number of patients Patient satisfaction is both anolder adults “excellent” responded “Excellent” to the who responded “Excellent” to the who completed a indicator of quality of care and a question regarding care of older survey question “How is this survey component of quality care. When patients doctor’s office at taking care of individual needs are perceived as older patients?” being met, better care results.Patient would Patients in the sample who Number of patients in the sample Number of patients Patient satisfaction is both anrecommend practice to reported that they would who reported that they would who completed a indicator of quality of care and aother older adults recommend this practice to other recommend this practice to other survey component of quality care. older adults older adultsCare of the Vulnerable Elderly Measure Catalog September 2010 Page 17 of 22
  18. 18. PATIENT EXPERIENCE: CARE OF THE VULNERABLE ELDERLY – PROCESSES OF CAREScreening and EvaluationMeasure Title Description Numerator Denominator RationaleVision testing within Patients in the sample who Number of patients in the sample Number of patients Aging is associated with changes inpast 24 months - PtSrv reported having had their vision who reported having had their who completed a visual acuity, development of checked within the past two vision checked within the past survey cataracts, macular degeneration, years two years glaucoma, and other conditions.Preventive CareMeasure Title Description Numerator Denominator RationaleSmoking cessation Patients in the sample who Number of patients in this Number of surveyedcounseling - PtSrv responded "Yes, more than sample who responded "Yes, patients that are once" to the survey question "If more than once" to the survey smokers you smoke, has your doctor question "If you smoke, has your advised you to stop?" doctor advised you to stop?"Physical ActivityMeasure Title Description Numerator Denominator RationalePatient asked about Patients in the sample who Number of patients in the sample Number of patients Research supports thelevel of physical activity reported being asked about level who reported being asked about who completed a recommendation that exercise (i.e., of physical activity level of physical activity survey resistance/strength training; balance, gait, and co-ordination training) helps to reduce falls.Advice to start, Patients in the sample who Number of patients in the sample Number of patients Research supports theincrease, or maintain reported receiving advice to who reported receiving advice to who completed a recommendation that exercise (i.e.,exercise program - start, increase, or maintain start, increase, or maintain survey resistance/strength training;PtSrv participation in an exercise participation in an exercise balance, gait, and co-ordination program that includes attention program that includes attention training) helps to reduce falls. to balance and strength to balance and strengthCare of the Vulnerable Elderly Measure Catalog September 2010 Page 18 of 22
  19. 19. AssessmentsMeasure Title Description Numerator Denominator RationalePatient asked about Patients in the sample who Number of patients in the sample Number of patients Hearing loss is associated withhearing problems reported that their doctor or who reported that their doctor or who completed a depression and decreased quality of someone in the office asked if someone in the office asked if survey life; it also can be mistaken for they had any problems with their they had any problems with their confusion or poor cooperation in hearing hearing older adults.Patient asked about Patients in the sample who Number of patients in the sample Number of patients Some loss of recent memory occursmemory concerns reported that their doctor or who reported that their doctor or who completed a in many older adults and generally someone in the doctors office someone in the doctors office survey is benign. However, memory loss asked if they had any concerns asked if they had any concerns that affects daily living should be about memory about memory evaluated carefully. Older adults may be aware of and concerned about subjective memory impairment, which is a risk factor for progression to dementia. Other causes of memory loss include depression, drug and alcohol effects, stroke, and head injury; some of these causes may be reversible.Patient has discussed Patients in the sample who Number of patients in the sample Number of patients All older patients (or theirfalls with doctor or reported having fallen during the who reported having fallen who completed a caregivers) should be asked at leastsomeone in the office past 12 months and who spoke during the past 12 months and survey and who once a year about falls, frequency of with their doctor or someone in who spoke with their doctor or reported having falling, and difficulties in gait or the office about falling someone in the office about fallen during the past balance. falling 12 monthsPatient has discussed Patients in the sample who Number of patients in the sample Number of patients Problems with gait and/or balanceproblems with reported having had a problem who reported having had a in the sample who should be evaluated in olderbalance/walking with with balance or walking during problem with balance or walking reported having had patients, particularly those whodoctor or someone in the past 12 months and who during the past 12 months and a problem with have had a fall.the office spoke with the doctor or who spoke with the doctor or balance or walking someone in the doctors office someone in the doctors office during the past 12 about the problem about the problem monthsPatient advised about Patients in the sample who Number of patients in the sample Number of patients A variety of interventions have beenhow to prevent falls reported having been advised who reported having been who completed a used to prevent falls in older adults. about how to prevent falls advised about how to prevent survey The most effective interventions are falls multicomponent, including exercise and education, and targeted to the individual patient.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 19 of 22
  20. 20. Urinary IncontinenceMeasure Title Description Numerator Denominator RationalePatient has bothersome Patients in the sample who Number of patients in the sample Number of patients Urinary incontinence is common inurinary incontinence reported having bothersome who reported having bothersome in the sample who older adults, and its prevalenceand has discussed it urine leakage and who reported urine leakage and who reported reported having increases with age. Incontinence iswith doctor or someone speaking with the doctor or speaking with the doctor bothersome urine associated with other commonin the office someone in the office about the someone in the office about the leakage (i.e., geriatric conditions, including prior problem problem answered "A big hysterectomy, obesity, prior stroke, problem" or "A small chronic obstructive pulmonary problem" to the disease, slow gait speed, and poor survey question overall health. It has a significant "How much of a negative impact on self-esteem and problem, if any, was quality of life; incontinence also is a the urine leakage for risk factor for depression, falls, and you?") nursing home placement. Surgical, medical, and behavioral treatments vary with the etiology; while not all patients will be interested in exploring treatment options, all can benefit from advice on managing the condition.Evaluation/treatment for Patients in the sample who Number of patients in the sample Number of patients Urinary incontinence is common inbothersome urinary reported having bothersome who reported having bothersome in the sample whose older adults, and its prevalenceincontinence - PtSrv urine leakage and who reported urine leakage and who reported incontinence was increases with age. Incontinence is receiving evaluation or treatment receiving evaluation or treatment bothersome enough associated with other common for it for it to ask about geriatric conditions, including prior treatment options hysterectomy, obesity, prior stroke, chronic obstructive pulmonary disease, slow gait speed, and poor overall health. It has a significant negative impact on self-esteem and quality of life; incontinence also is a risk factor for depression, falls, and nursing home placement. Surgical, medical, and behavioral treatments vary with the etiology; while not all patients will be interested in exploring treatment options, all can benefit from advice on managing the condition.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 20 of 22
  21. 21. Physician/Practice CommunicationsMeasure Title Description Numerator Denominator RationaleDoctor rated "excellent" Patients in the sample who rated Number of patients in the Number of patients Care should be patient-centered,at encouraging/ the doctor "Excellent" at sample who responded who completed a respectful of and responsive toanswering questions encouraging/answering “Excellent” to the survey survey, excluding individual patient preferences,clearly questions clearly question "How is this doctor at those who needs, and values and ensuring encouraging you to ask responded "Not that patient values guide all clinical questions and answering them applicable" to the decisions. Patients overall clearly?" question "How is experiences with doctors are this doctor at shaped by communication style encouraging you to and content; both contribute to the ask questions and likelihood that a patient will answering them understand and be able to follow clearly?" treatment recommendations.Staff rated "excellent" at Patients in the sample who rated Number of patients in the Number of patients Care should be patient-centered;encouraging/answering the staff "Excellent" at sample who responded who completed a respectful of and responsive toquestions encouraging/answering "Excellent" to the survey survey individual patient preferences, questions clearly question "How is this doctors needs, and values; and ensuring staff at encouraging you to ask that patient values guide all clinical questions and answering them decisions. Patients overall clearly?" experiences with a practice are shaped by communication style and content not only of the doctor, but also of the practice staff; these factors contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Doctor and staff rated Patients in the sample who rated Number of patients in the Number of patients Patients overall experiences with"excellent" at providing the practice "Excellent" at sample who responded who completed a doctors are shaped byinformation on taking providing information on taking “Excellent” to the survey survey, excluding communication style and content;medications properly medications properly question "How is this practice at those who both contribute to the likelihood that making sure you have the responded "Not a patient will understand and be information you need to take applicable" to the able to follow treatment your medications properly?" question "How is recommendations. Helping patients this practice at understand their medications, both making sure you prescription and over-the-counter have the information drugs, is an essential part of health you need to take care. your medicationsCare of the Vulnerable Elderly Measure Catalog September 2010 Page 21 of 22
  22. 22. Physician/Practice CommunicationsMeasure Title Description Numerator Denominator Rationale properly?"Doctor and staff rated Patients in the sample who rated Number of patients who Number of patients Patients overall experiences with"excellent" at providing the practice "Excellent" at responded "Excellent" to the who completed a doctors are shaped byinformation on providing information on survey question "How is this survey, excluding communication style and content;medication side effects medication side effects practice at giving you those who both contribute to the likelihood that information about side effects of responded "Not a patient will understand and be your medications?" applicable" to the able to follow treatment question "How is recommendations. Helping patients this practice at understand their medications, giving you including potential side effects, is information about an essential part of health care. side effects of your medications?"© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction oradaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.Care of the Vulnerable Elderly Measure Catalog September 2010 Page 22 of 22

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