Home › Research › End-of-life care
Assessing Care of Vulnerable Elders: ACOVE Project Overview
Neil S. Wenger, Paul Shekelle, and the ACOVE Investigators*. Annals of Internal Medicine, 2001-10-16
Topic: Health services, long-term care and technology
Such targeted approaches may not present a fair picture of overall quality and may lead to unintended incentives ("gaming the system") (7). This committee reviewed the sampling system, considered the value of a community survey–based sample versus a sample drawn from administrative data, advised the project on methods of data collection, and advocated the use of process measures rather than outcomes.Project OverviewThe Appendix lists the members and institutional affiliations of the Clinical Committee and the Policy Advisory Committee and ACOVE investigators and staff.Definition and Selection of the Patient SampleWe termed our target sample "vulnerable elders." With the assistance of the Clinical Committee, we defined "vulnerable elders" as persons 65 years of age and older who are at increased risk for death or functional decline.We considered several methods of identifying a community-based sample for measurement, including use of administrative data and survey sampling. Using these factors, we developed a scoring system that identified 32% of a nationally representative sample as vulnerable: This group had more than four times the risk for death or functional decline over a 2-year period compared to the lower-scoring majority of the sample (10). If an indicator states that a care process should be "offered" to a patient, this indicator is satisfied if the care process occurs, if the medical record (or patient interview) indicates that the patient rejected the care process, or if the medical record (or patient interview) documents that the care process was offered to the patient.4. Performance on the measures could be used to assess the overall care delivered to vulnerable elders by a plan, medical group, or health system.
Key findings
- Such targeted approaches may not present a fair picture of overall quality and may lead to unintended incentives ("gaming the system") (7).
- This committee reviewed the sampling system, considered the value of a community survey–based sample versus a sample drawn from administrative data, advised the project on methods of data collection, and advocated the use of process measures rather than outcomes.Project OverviewThe Appendix lists the members and institutional affiliations of the Clinical Committee and the Policy Advisory Committee and ACOVE investigators and staff.Definition and Selection of the Patient SampleWe termed our target sample "vulnerable elders." With the assistance of the Clinical Committee, we defined "vulnerable elders" as persons 65 years of age and older who are at increased risk for death or functional decline.We considered several methods of identifying a community-based sample for measurement, including use of administrative data and survey sampling.
- Using these factors, we developed a scoring system that identified 32% of a nationally representative sample as vulnerable: This group had more than four times the risk for death or functional decline over a 2-year period compared to the lower-scoring majority of the sample (10).
- If an indicator states that a care process should be "offered" to a patient, this indicator is satisfied if the care process occurs, if the medical record (or patient interview) indicates that the patient rejected the care process, or if the medical record (or patient interview) documents that the care process was offered to the patient.4.
- Performance on the measures could be used to assess the overall care delivered to vulnerable elders by a plan, medical group, or health system.
Study details
- Study designsystematic review
- Participants200
- Evidence strengthHigh
How this study scored 76/100
Published in a leading specialty journal, and it is a systematic review of all the studies on the question. Scored zero for effect reported because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 44 of the 58 points we could judge it on, which is 76 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of Internal Medicine) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2001 — older than 20 years, still counted |
| Sample size | 2 / 4 | 200 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 11601946) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 44 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 44 of the 58 points we could judge it on is 76 out of 100. |
| Total | 76 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Wenger, N. S., Shekelle, P., & the ACOVE Investigators. (2001). Assessing Care of Vulnerable Elders: ACOVE Project Overview. Annals of Internal Medicine. https://doi.org/10.7326/0003-4819-135-8_part_2-200110161-00002
Vancouver
Wenger NS, Shekelle P, the ACOVE Investigators. Assessing Care of Vulnerable Elders: ACOVE Project Overview. Annals of Internal Medicine. 2001. doi:10.7326/0003-4819-135-8_part_2-200110161-00002. PMID: 11601946.
BibTeX
@article{wenger2001-11601946,
author = {Wenger, Neil S. and Shekelle, Paul and {the ACOVE Investigators}},
title = {{Assessing Care of Vulnerable Elders: ACOVE Project Overview}},
journal = {Annals of Internal Medicine},
year = {2001},
doi = {10.7326/0003-4819-135-8_part_2-200110161-00002},
pmid = {11601946},
url = {https://doi.org/10.7326/0003-4819-135-8_part_2-200110161-00002}
}
Related studies in End-of-life care
Also tagged “assisted-living”
199 studies in the library carry the topic tag “assisted-living”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 199 tagged studies.