Neil S. Wenger, MD, MPH; David H. Solomon, MD; Carol P. Roth, RN, MPH; Catherine H. MacLean, MD, PhD; Debra Saliba, MD; Caren J. Kamberg, MSPH; Laurence Z. Rubenstein, MD, MPH; Roy T. Young, MD; Elizabeth M. Sloss, PhD; Rachel Louie, MS; John Adams, PhD; John T. Chang, MD, MPH; Patricia J. Venus, MA; John F. Schnelle, PhD; Paul G. Shekelle, MD, PhD
Acknowledgments: The authors thank Robert Brook, MD, ScD, for initiating this project and for providing inspiration and guidance throughout the work. Robin P. Hertz, PhD, senior director of outcomes research/population studies at Pfizer Inc, provided valuable support. They also recognize the expert assistance of Dr. Ralph Levinson, who provided ophthalmologic chart review, and the technical assistance of Patricia Smith.
Grant Support: By a grant from Pfizer Inc to RAND.
Potential Financial Conflicts of Interest:Stock ownership or options (other than mutual funds): D.H. Solomon, R.T. Young, R. Louie (Pfizer Inc).
Requests for Single Reprints: Neil S. Wenger, MD, RAND, 1700 Main Street, M-26, Santa Monica, CA 90407-2138; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Wenger, Solomon, MacLean, Saliba, and Adams; Ms. Roth; and Ms. Louie: RAND, 1700 Main Street, M-26, Santa Monica, CA 90407-2138.
Ms. Kamberg and Dr. Sloss: RAND, 1200 South Hayes Street, Arlington, VA 22202.
Dr. Rubenstein: Geriatric Research Education and Clinical Center, Sepulveda Veterans Affairs Medical Center, 16111 Plummer Street, 11E, Sepulveda, CA 91343.
Dr. Young: Division of General Internal Medicine, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.
Dr. Chang: Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095-1736.
Ms. Venus: Center for Health Care Policy and Evaluation, 12125 Technology Drive, MN002-0260, Minneapolis, MN 55344.
Dr. Schnelle: University of California, Los Angeles, 7150 Tampa Avenue, Reseda, CA 91335.
Dr. Shekelle: Greater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.
Author Contributions: Conception and design: N.S. Wenger, D.H. Solomon, C.P. Roth, C.H. MacLean, D. Saliba, L.Z. Rubenstein, R.T. Young, E.M. Sloss, J.T. Chang, J.F. Schnelle, P.G. Shekelle.
Analysis and interpretation of the data: N.S. Wenger, D.H. Solomon, C.P. Roth, C.H. MacLean, D. Saliba, L.Z. Rubenstein, R.T. Young, R. Louie, J. Adams, J.T. Chang, P.G. Shekelle.
Drafting of the article: N.S. Wenger, J.T. Chang.
Critical revision of the article for important intellectual content: N.S. Wenger, D.H. Solomon, C.H. MacLean, D. Saliba, C.J. Kamberg, L.Z. Rubenstein, E.M. Sloss, R. Louie, J.T. Chang, P.G. Shekelle.
Final approval of the article: N.S. Wenger, D.H. Solomon, C.P. Roth, C.H. MacLean, D. Saliba, C.J. Kamberg, L.Z. Rubenstein, E.M. Sloss, R. Louie, J.T. Chang, J.F. Schnelle, P.G. Shekelle.
Provision of study materials or patients: C.P. Roth, P.J. Venus.
Statistical expertise: J. Adams.
Administrative, technical, or logistic support: C.P. Roth, C.J. Kamberg, E.M. Sloss, J.T. Chang.
Collection and assembly of data: D.H. Solomon, C.P. Roth, C.J. Kamberg, R.T. Young, R. Louie, J.T. Chang, P.J. Venus, P.G. Shekelle.
Wenger N., Solomon D., Roth C., MacLean C., Saliba D., Kamberg C., Rubenstein L., Young R., Sloss E., Louie R., Adams J., Chang J., Venus P., Schnelle J., Shekelle P.; The Quality of Medical Care Provided to Vulnerable Community-Dwelling Older Patients. Ann Intern Med. 2003;139:740-747. doi: 10.7326/0003-4819-139-9-200311040-00008
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Published: Ann Intern Med. 2003;139(9):740-747.
The quality of care among patients 65 years of age and older has not been extensively investigated, and most existing studies have focused on general adult medical conditions. This is surprising, considering that more than 40% of all medical expenditures are for persons 65 years of age and older (1). The most comprehensive study to date of quality of care among older patients evaluated 24 process indicators among U.S. Medicare beneficiaries in all 50 states between 1997 and 1999 (2). Care for acute myocardial infarction, heart failure, stroke, and pneumonia was evaluated by using inpatient medical records. Pneumonia, breast cancer, and diabetes indicators were evaluated by using survey and Medicare claims data. The investigators found that the percentage of patients receiving appropriate care varied widely by measure and state. Several other studies of older patients evaluated cardiovascular conditions, diabetes, or aspects of preventive care and medication use (3-10). No study, however, has assessed the quality of medical care provided for geriatric conditions that profoundly affect the lives of vulnerable older patients. Furthermore, surveys find that older persons often prioritize function and comfort over disease treatment and prolongation of life (11).
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