Multiplexed assays of variant effect (MAVEs) have emerged as a powerful approach for interrogating thousands of genetic variants in a single experiment. The flexibility and widespread adoption of ...these techniques across diverse disciplines have led to a heterogeneous mix of data formats and descriptions, which complicates the downstream use of the resulting datasets. To address these issues and promote reproducibility and reuse of MAVE data, we define a set of minimum information standards for MAVE data and metadata and outline a controlled vocabulary aligned with established biomedical ontologies for describing these experimental designs.
Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the ...University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community‐based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE‐3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community‐dwelling adults with dementia referred to the UCLA ADC program over a 2‐year period. UCLA is an urban academic medical center with primarily fee‐for‐service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were ed from DCM notes over a 3‐month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90–96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient‐specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive dementia care comanagement with a nurse practitioner can result in high quality of care for dementia, especially for assessment, screening, and counseling. The effect on treatment QIs is more variable but higher than previous reports of physician‐provided dementia care.
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Many people 65 years of age and older are at risk for functional decline and death. However, the resource-intensive medical care provided to this group has received little evaluation. Previous ...studies have focused on general medical conditions aimed at prolonging life, not on geriatric issues important for quality of life.
To measure the quality of medical care provided to vulnerable elders by evaluating the process of care using Assessing Care of Vulnerable Elders quality indicators (QIs).
Observational cohort study.
Managed care organizations in the northeastern and southwestern United States.
Vulnerable older patients identified by a brief interview from a random sample of community-dwelling adults 65 years of age or older who were enrolled in 2 managed care organizations and received care between July 1998 and July 1999.
Percentage of 207 QIs passed, overall and for 22 target conditions; by domain of care (prevention, diagnosis, treatment, and follow-up); and by general medical condition (for example, diabetes and heart failure) or geriatric condition (for example, falls and incontinence).
Patients were eligible for 10 711 QIs, of which 55% were passed. There was no overall difference between managed care organizations. Wide variation in adherence was found among conditions, ranging from 9% for end-of-life care to 82% for stroke care. More treatment QIs were completed (81%) compared with other domains (follow-up, 63%; diagnosis, 46%; and prevention, 43%). Adherence to QIs was lower for geriatric conditions than for general medical conditions (31% vs. 52%; P < 0.001).
Care for vulnerable elders falls short of acceptable levels for a wide variety of conditions. Care for geriatric conditions is much less optimal than care for general medical conditions.
Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well ...understood.
To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.
Observational cohort study.
2 managed care organizations.
Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period.
Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview.
Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care.
Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage.
Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality.
OBJECTIVES: To determine whether a practice redesign intervention coupled with referral to local Alzheimer's Association chapters can improve the quality of dementia care.
DESIGN: Pre–post ...intervention.
SETTING: Two community‐based physician practices.
PARTICIPANTS: Five physicians in each practice and their patients aged 75 and older with dementia.
INTERVENTION: Adaptation of the Assessing Care of Vulnerable Elders (ACOVE)‐2 intervention (screening, efficient collection of clinical data, medical record prompts, patient education and empowerment materials, and physician decision support and education). In addition, physicians faxed referral forms to local Alzheimer's Association chapters, which assessed patients, provided counseling and education, and faxed information back to the physicians.
MEASUREMENTS: Audits of pre‐ (5 per physician) and postintervention (10 per physician) medical records using ACOVE‐3 quality indicators for dementia to measure the quality of care provided.
RESULTS: Based on 47 pre‐ and 90 postintervention audits, the percentage of quality indicators satisfied rose from 38% to 46%, with significant differences on quality indicators measuring the assessment of functional status (20% vs 51%), discussion of risks and benefits of antipsychotics (32% vs 100%), and counseling caregivers (2% vs 30%). Referral of patients to Alzheimer's Association chapters increased from 0% to 17%. Referred patients had higher quality scores (65% vs 41%) and better counseling about driving (50% vs 14%), caregiver counseling (100% vs 15%), and surrogate decision‐maker specification (75% vs 44%). Some quality indicators related to cognitive assessment and examination did not improve.
CONCLUSION: This pilot study suggests that a practice‐based intervention can increase referral to Alzheimer's Association chapters and improve quality of dementia care.
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Although assessment of the quality of medical care often relies on measures of process of care, the linkage between performance of these process measures during usual clinical care and subsequent ...patient outcomes is unclear.
To examine the link between the quality of care that patients received and their survival.
Observational cohort study.
Two managed care organizations.
Community-dwelling high-risk patients 65 years of age or older who were continuously enrolled in the managed care organizations from 1 July 1998 to 31 July 1999.
Quality of care received by patients (as measured by a set of quality indicators covering 22 clinical conditions) and their survival over the following 3 years.
The 372 vulnerable older patients were eligible for a mean of 21 quality indicators (range, 8 to 54) and received, on average, 53% of the care processes prescribed in quality indicators (range, 27% to 88%). Eighty-six (23%) persons died during the 3-year follow-up. There was a graded positive relationship between quality score and 3-year survival. After adjustment for sex, health status, and health service use, quality score was not associated with mortality for the first 500 days, but a higher quality score was associated with lower mortality after 500 days (hazard ratio, 0.64 95% CI, 0.49 to 0.84 for a 10% higher quality score).
The observational design limits causal inference regarding the effect of quality of care on survival.
Better performance on process quality measures is strongly associated with better survival among community-dwelling vulnerable older adults.
Patients with a primary mental health condition account for nearly 10% of pediatric hospitalizations nationally, but little is known about the quality of care provided for them in hospital settings. ...Our objective was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings.
We drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings. We used the modified Delphi method to prioritize measures; 2 ED and 6 inpatient measures were operationalized and field-tested in 2 community and 3 children's hospitals. Eligible patients were 5 to 19 years old and diagnosed with psychosis, suicidality, or substance use from January 2012 to December 2013. We used bivariate and multivariate models to examine measure performance by patient characteristics and by hospital.
Eight hundred and seventeen records were abstracted with primary diagnoses of suicidality (
= 446), psychosis (
= 321), and substance use (
= 50). Performance varied across measures. Among patients with suicidality, male patients (adjusted odds ratio: 0.27,
< .001) and African American patients (adjusted odds ratio: 0.31,
= .02) were less likely to have documentation of caregiver counseling on lethal means restriction. Among admitted suicidal patients, 27% had documentation of communication with an outside provider, with variation across hospitals (0%-38%;
< .001). There was low overall performance on screening for comorbid substance abuse in ED patients with psychosis (mean: 30.3).
These new pediatric mental health care quality measures were used to identify sex and race disparities and substantial hospital variation. These measures may be useful for assessing and improving hospital-based pediatric mental health care quality.
Objective:Information sharing between mental health providers (MHPs) and primary care providers (PCPs) is important for persons with mental illnesses. The authors determined the level of information ...continuity between MHPs who saw a patient for a new consult and PCPs and whether continuity varied between providers with and without access to a shared electronic health record (EHR).Methods:Data were analyzed for 141 randomly selected enrollees in six Medicare Advantage plans receiving a new outpatient mental health consultation in 2012. Medical records of MHPs and PCPs were abstracted to evaluate whether PCP records recognized the consultation, documented mental health hospitalizations and emergency department visits, and acknowledged psychotropic medications. Measures were compared between patients whose providers used and did not use mutual-access EHRs.Results:For 21% of patients, the PCP record documented communication from the MHP within three months of the consultation. The PCP record showed evidence of timely communication (within seven days) for 42% of mental health hospitalizations and emergency department visits. Of 152 medications recorded by MHPs, 103 (68%) were acknowledged in the PCP record by the next visit. For patients with mutual-access EHRs, provider communication about the consultation was documented for a greater percentage of patients, compared with those without mutual-access EHRs (46% versus 11%, p<.001), as was communication about psychotropic medication (100% versus 57%, p<.001).Conclusions:This small but detailed study of patients receiving new outpatient mental health consults found poor continuity of information between MHPs and PCPs. A mutual-access EHR facilitated but did not guarantee such information sharing.
Transitions between sites of care are inherent to all hospitalizations, yet we lack pediatric-specific transitions-of-care quality measures. We describe the development and validation of new ...transitions-of-care quality measures obtained from medical record data.
After an evidence review, a multistakeholder panel prioritized quality measures by using the RAND/University of California, Los Angeles modified Delphi method. Three measures were endorsed, operationalized, and field-tested at 3 children's hospitals and 2 community hospitals: quality of hospital-to-home transition record content, timeliness of discharge communication between inpatient and outpatient providers, and ICU-to-floor transition note quality. Summary scores were calculated on a scale from 0 to 100; higher scores indicated better quality. We examined between-hospital variation in scores, associations of hospital-to-home transition quality scores with readmission and emergency department return visit rates, and associations of ICU-to-floor transition quality scores with ICU readmission and length of stay.
A total of 927 charts from 5 hospitals were reviewed. Mean quality scores were 65.5 (SD 18.1) for the hospital-to-home transition record measure, 33.3 (SD 47.1) for the discharge communication measure, and 64.9 (SD 47.1) for the ICU-to-floor transition measure. The mean adjusted hospital-to-home transition summary score was 61.2 (SD 17.1), with significant variation in scores between hospitals (P < .001). Hospital-to-home transition quality scores were not associated with readmissions or emergency department return visits. ICU-to-floor transition note quality scores were not associated with ICU readmissions or hospital length of stay.
These quality measures were feasible to implement in diverse settings and varied across hospitals. The development of these measures is an important step toward standardized evaluation of the quality of pediatric transitional care.
OBJECTIVES: To update and increase the comprehensiveness of the Assessing Care of Vulnerable Elders (ACOVE) set of process‐of‐care quality indicators (QIs) for the medical care provided to vulnerable ...elders and to keep up with the constantly changing medical literature, the QIs were revised and expanded.
DESIGN: The ACOVE Clinical Committee expanded the number of measured conditions to 26 in the revised (ACOVE‐3) set. For each condition, a content expert created potential QIs and, based on systematic reviews, developed a peer‐reviewed monograph detailing each QI and its supporting evidence. Using these literature reviews, multidisciplinary panels of clinical experts participated in two rounds of anonymous ratings and a face‐to‐face group discussion to evaluate whether the QIs were valid measures of quality of care using a process that is an explicit combination of scientific evidence and professional consensus. The Clinical Committee evaluated the coherence of the complete set of QIs that the expert panels rated as valid.
RESULTS: ACOVE‐3 contains 392 QIs covering 14 different types of care processes (e.g., taking a medical history, performing a physical examination) and all four domains of care: screening and prevention (31% of QIs), diagnosis (20%), treatment (35%), and follow‐up and continuity (14%). All QIs also apply to community‐dwelling patients aged 75 and older.
CONCLUSION: ACOVE‐3 contains a set of QIs to comprehensively measure the care provided to vulnerable older persons at the level of the health system, health plan, or medical group. These QIs can be applied to identify areas of care in need of improvement and can form the basis of interventions to improve care.
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