Geriatricians and quality assurance

Integration of Research Methods and Outcome Measures: Comprehensive Care for the Frail Elderly

Les instruments de recherche peuvent être intégrées dans les soins de routine si ceux-ci sont utiles aux pourvoyeurs de soins. Ainsi, ils sont utiles s'ils facilitent la prestation de soins et si ce qu'ils mesurent reflètent des résultats qui importent aux patients. Bon nombre de mesures actuelles sont moins utiles parce qu'elles ne peuvent servir dans le quotidien ou mesurent de façon inadéquate les résultats pertinents. Au plan des soins auprès des personnes âgées frêles, qui ont des besoins complexes, ces défis sont particulièrement difficiles à relever. Les techniques d'évalutation gériatrique complète et l'établissement d'une échelle de l'atteinte des objectifs (Goal Attainment Scaling — GAS) sont proposées comme des moyens d'englober la complexité des besoins des personnes âgées frêles et de mesurer l'efficacité des interventions spécialisées. L'échelle GAS est conforme à la définition de la qualité de la vie de l'instrument Health-Related Quality of Life. Ce qui suggère que son utilisation dans le quotidien offre des avantages tant au niveau de la gestion que de la mesure des résultats.

Physician participation in TQM in geriatric medicine

BACKGROUND

Quality improvement (QI) approaches such as total quality management (TQM) and continuous quality improvement (CQI) have great potential for improving the care provided to older people. Geriatricians have the necessary experience and skills to initiate and lead these QI efforts. A national sample of practicing geriatricians was surveyed in 1998 regarding involvement in, satisfaction with, and insights regarding TQM processes in four care settings.

RESULTS

Of 537 questionnaires returned in time for analysis, 497 were included for analysis after omitting questionnaires that were undeliverable or unusable (n = 25) and those from respondents who worked fewer than 20 hours per week (n = 15). More than one-third of the respondents (37.1%) reported no TQM activity at all. For the remainder, the primary site for TQM activity was the nursing home (33.0%), the hospital (22.5%), the office (11.4%), and the patient's home (3.7%). A majority of the respondents spent two hours per week or less on TQM projects. Planning an intervention and acting to maintain it in practice after its evaluation were the two stages of the improvement cycle these respondents engaged in most frequently.

DISCUSSION

More geriatricians should be encouraged to participate in TQM training and in specific projects to improve systems of care for older people. Incentives to increase participation should be made available. Rapid-cycle improvement may fit better with physicians' culture of working for outcomes that have relatively short turnaround times.