Stephanie L. Garrett, MD; James G. O'Brien, MD; Toni P. Miles, MD, PhD
Potential Financial Conflicts of Interest: None disclosed.
Garrett SL, O'Brien JG, Miles TP. Quality of Care for Vulnerable Older Patients. Ann Intern Med. 2006;144:219. doi: 10.7326/0003-4819-144-3-200602070-00016
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Published: Ann Intern Med. 2006;144(3):219.
TO THE EDITOR:
In a recent meeting of our fellows and departmental faculty, we discussed the findings of Higashi and colleagues (1). We were considerably excited because we are committed to quality care for our frail older patients. To our surprise, the analyses as presented did not support the conclusions.
The authors state that for 8 of the 9 quality indicators that they defined, “patients who received recommended care were less likely to die than those who did not receive such care (Table 2).” Only 1 of these 9 quality indicators was significant—the exact opposite of the text. Pneumococcal vaccine lowered the risk for death by 54% whereas all the others did not alter risk. Figure 1, which compared high-quality and low-quality care groups, showed a clear separation only after 800 days. During the first 400 days, the lines were indistinguishable. The authors used the Vulnerable Elders Survey-13 (VES-13) to create the sample. According to the survey's creators (2), patients whose score on the VES-13 is 3 or higher have a risk for death within the next 2 years that is 4 times higher than that of patients with lower scores. During the 3-year follow-up period of the study by Higashi and associates, 23% of patients in the overall sample died. The paper does not report the proportion of patients who died by categories of quality score.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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