Evaluation of a guided protocol for quality improvement in identifying common geriatric problems.
OBJECTIVES: Many common geriatric problems are underrecognized and undertreated. A simple and reliable tool to facilitate a standard approach to evaluating geriatric patients might improve the quality of medical care delivered to geriatric patients. The objective of this study was to evaluate a standardized, semistructured quality-improvement protocol (the guided geriatric care protocol) for the assessment of common geriatric problems. DESIGN: Sequential comparison cohorts, with chart review to evaluate study measures before and after introduction of the guided geriatric care protocol. SETTING: The outpatient consultative geriatric assessment center of Yale-New Haven Hospital in New Haven, Connecticut. PARTICIPANTS: One hundred consecutive new patients before and 100 consecutive new patients after introduction of the guided geriatric care protocol. MEASUREMENTS: Number and type of problems identified and recommendations made during the clinical encounter, duration of the clinical encounter, clinician acceptance. RESULTS: The two patient groups were similar in sociodemographics, cognitive and functional status, and reasons for evaluation. Significantly more problems were identified after (mean 5.51) than before (mean 3.49) introduction of the guided geriatric care protocol (P< .001); likewise, significantly more recommendations were made after (mean 10.45) than before (mean 8.48) introduction of the protocol (P< .001). The duration of the clinical encounter did not differ significantly between the two groups. The protocol was well accepted by participating clinicians. CONCLUSIONS: Use of the guided geriatric care protocol assured a standard approach to evaluating common geriatric problems and may have led to the identification and treatment of more problems than usual care without increasing the duration of the clinical encounter. A quality-improvement tool that standardizes the evaluation of common geriatric problems, if validated in other clinical settings, holds the potential to improve the quality of care for vulnerable older patients.