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The Quality of Pharmacologic Care for Vulnerable Older Patients

Takahiro Higashi, MD; Paul G. Shekelle, MD, PhD; David H. Solomon, MD; Eric L. Knight, MD, MPH; Carol Roth, RN, MPH; John T. Chang, MD, MPH; Caren J. Kamberg, MSPH; Catherine H. MacLean, MD, PhD; Roy T. Young, MD; John Adams, PhD; David B. Reuben, MD; Jerry Avorn, MD; and Neil S. Wenger, MD, MPH
[+] Article and Author Information

From the University of California, Los Angeles, and the Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California and Washington, DC; and Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.


Acknowledgments: The authors thank Robert Brook, MD, ScD, for his guidance and Patricia Smith and Victor Gonzalez for technical assistance.

Grant Support: By a contract from Pfizer Inc. to RAND. Dr. Shekelle is a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service. Dr. Chang is supported by a National Research Service Award (PE-19001) and the University of California, Los Angeles, Specialty Training and Advanced Research (STAR) Program.

Potential Financial Conflicts of Interest:Stock ownership or options (other than mutual funds): Roy T. Young (Pfizer Inc.); Grants received: J. Avorn (Pfizer Inc., Bristol-Myers Squibb, Novo Nordisk, Pharmacia).

Requests for Single Reprints: Takahiro Higashi, MD, Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095.

Current Author Addresses: Drs. Higashi and Chang: Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Plaza, Los Angeles, CA 90095-1736.

Dr. Shekelle: Greater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Drs. Solomon, MacLean, Adams, and Wenger and Ms. Roth: RAND, 1700 Main Street, M-26, Santa Monica, CA 90407-2138.

Drs. Knight and Avorn: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 221 Longwood Avenue, Suite 341, Boston, MA 02115.

Ms. Kamberg: RAND, 1200 South Hayes Street, Arlington, VA 22202.

Dr. Young: Division of General Internal Medicine, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.

Dr. Reuben: Division of Geriatrics, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.


Ann Intern Med. 2004;140(9):714-720. doi:10.7326/0003-4819-140-9-200405040-00011
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The ACOVE project developed a set of explicit quality indicators to evaluate the care provided to vulnerable older persons (2224). The system focuses on processes of care within the domains of prevention, diagnosis, treatment, and follow-up and covers the spectrum of care contained in 22 conditions that are important in the care of older patients (7). The methods for selecting conditions and developing the quality indicators are described in detail elsewhere (7, 23). Methods included systematic literature reviews and multiple layers of expert judgment (23). The literature review resulted in proposal of candidate quality indicators, which were reviewed by an expert panel that rated each of the proposed quality indicators for validity and feasibility. This set was modified and approved by a clinical committee of national geriatric experts and by the American College of Physicians Task Force on Aging (24). From the final ACOVE set of quality indicators, 43 quality indicators (Table 1 and Appendix Table) that pertained to pharmacologic care and had more than 5 eligible patients are included in this analysis.

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Summary for Patients

The Quality of Pharmacologic Care for Older Adults in Two Managed Care Organizations

The summary below is from the full report titled “The Quality of Pharmacologic Care for Vulnerable Older Patients.” It is in the 4 May 2004 issue of Annals of Internal Medicine (volume 140, pages 714-720). The authors are T. Higashi, P.G. Shekelle, D.H. Solomon, E.L. Knight, C. Roth, J.T. Chang, C.J. Kamberg, C.H. MacLean, R.T. Young, J. Adams, D.B. Reuben, J. Avorn, and N.S. Wenger.

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