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

<p>Abstract</p> <p>Background</p> <p>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).</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

No association between serum 25-Hydroxyvitamin D3 level and performance on psychometric tests in NHANes III

Background: Animal studies and in vitro experiments indicate that vitamin D is involved in a diverse range of neurobiological functions. We had the opportunity to examine the relationship between serum 25-hydroxyvitamin D 3 [25( OH) D] levels and performance on various cognitive tasks, based on a large, representative community sample. Methods: Three age groups were available from the population-based NHANES III survey: adolescent group (n = 1,676, age range 12 - 17 years), adult group (n = 4,747, 20 - 60 years), elderly group (n = 4,809, 60 - 90 years). The associations between eight psychometric measures and serum 25(OH) D were assessed. Results: In the adolescent and adult groups, none of the psychometric measures were associated with 25(OH) D levels. In the elderly group there was a significant difference between 25(OH) D quintiles performance on a learning and memory task; however, those with the highest quintile of 25(OH) D were most impaired on the task, contrary to the hypotheses. Conclusion: Lower 25(OH) D levels were not associated with impaired performance on various psychometric measures. While it remains to be seen if chronic exposure to low 25( OH) D levels alters brain function in the long term, this cross-sectional study suggests that 25( OH) D levels do not influence neurocognitive performance