Comparative trial of a web-based tool to improve the quality of care provided to older adults in residency clinics: modest success and a tough road ahead.

ABSTRACT

PURPOSE: To determine whether residency programs can use a multicomponent, Web-based quality improvement tool to improve the care of older adults. METHOD: The authors conducted an exploratory, cluster-randomized, comparative before-after trial of the Care of the Vulnerable Elderly Practice Improvement Module in the ambulatory clinics of 46 internal medicine and family medicine residency programs, 2006-2008. The main outcomes were the deltas between pre- and post-performance on the Assessing Care of the Vulnerable Elderly (ACOVE) quality measures. RESULTS: Of the 46 programs initially selected for the study, 37 (80%) provided both baseline and follow-up data. Performance on all 10 ACOVE measures was poor at baseline (range 8.6%-33.6%). Intervention clinics most frequently chose for improvement fall-risk screening and documentation of end-of-life preferences. The change in the percentage of patients screened for fall risk for the intervention clinics that targeted this measure was significantly greater than the change observed by the control clinics (+23.3% versus +9.7%, P = .003, odds ratio [OR] = 2.0; 95% confidence interval [CI] 1.25-3.75), as was the difference observed for documentation of preference for life-sustaining care (+16.4% versus +2.8%, P = .002, OR = 6.3; 95% CI 2.0-19.6) and surrogate decision maker (+14.3% versus +2.8%, P = .003, OR = 6.8; 95% CI 1.9-24.4). CONCLUSIONS: A multicomponent, Web-based, quality improvement tool can help residency programs improve care for older adults, but much work remains for improving the state of care for this population in training settings.