ABSTRACT
OBJECTIVES: In light of large variation in the quality of medical care, this study assesses the extent to which medical care for depressed elders is consistent with systematic quality standards. METHOD: Using the Donabedian model, we assess factors related to two quality measures: medical service fit and medical provider contact. We assessed 110 depressed older adults with comorbid conditions through practical guidelines of medical services. RESULTS: We found large variation in the quality of medical care and differences between two quality measures. Structure (Medigap insurance and clinical factors) and process factors (medical professional visits, ER visits, and adequacy of informal care) influenced the quality of medical care. CONCLUSION: Emphasizing accuracy in quality measures, quality disparities by medical conditions call attention to the risky population with certain conditions targeted for closer follow-up. Appropriate medical care processes can enhance the quality.
Subject(s)
Depressive Disorder/epidemiology , Depressive Disorder/therapy , Quality Indicators, Health Care , Quality of Health Care/standards , Age Factors , Aged , Comorbidity , Depressive Disorder/diagnosis , Female , Geriatric Assessment , Guidelines as Topic , Health Services Research/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Insurance, Medigap/statistics & numerical data , Male , Outcome and Process Assessment, Health Care , Personality Inventory/statistics & numerical data , Quality Assurance, Health Care/methods , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The authors examined physical illness among elderly patients hospitalized for treatment of major depression, the impact of comorbidity on functional status, and the burden of comorbidity on post-discharge service needs. METHODS: Data for this cross-sectional study were derived from patient interviews and abstracted from hospital charts. The sample comprised 195 older adults hospitalized for treatment of depression on the geropsychiatric unit of a large urban teaching hospital and discharged to home. Medical comorbidity was measured with the Cumulative Illness Rating Scale for Geriatrics. A psychiatrist confirmed DSM-IV for Axis I diagnosis of depression, and the Geriatric Depression Scale measured depression severity. Unit nurses administered the Mini-Mental State Exam. They assessed functional dependency via the OARS Multidimensional Functional Assessment Questionnaire. Service needs post-discharge were measured from physician discharge orders and patient scores on standardized tests. RESULTS: Almost three-fourths of depressed elderly patients had at least one comorbid condition requiring first-line treatment; nearly half had two, and one-fourth had three or more. Comorbid physical illness and cognitive impairment was significantly and negatively associated with elderly patients' functional impairment at discharge. Depressed patients with higher medical comorbidity had significantly more needs for services after they left acute care. CONCLUSION: Medical comorbidity needs to be assessed and considered in planning for post-acute care for depressed elderly patients discharged home.
