Improving Quality of Care for Elderly Patients in the Educational Setting

NCT ID: NCT01080235

Last Updated: 2010-03-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 42 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2006-10-31
• Study Completion Date: 2008-12-31

Brief Summary

This is a multi-center exploratory study (each site got local IRB approval) of the impact of an educational toolkit combined with a practice-performance self-evaluation instrument (ABIM Care of the Vulnerable Elderly Practice Improvement Module) on trainee knowledge, skills, and attitudes about practice-based learning and improvement and systems-based practice in the care of elderly patients.

Detailed Description

This is a longitudinal quasi-experimental study. Programs will be randomly assigned to either the comparison or intervention group, stratified based on program size, affiliation, geographic location, and presence of a geriatrics fellowship program.

Faculty will be trained in use of the CoVE PIM and in the development and implementation of a quality improvement plan. Residents in the intervention group will perform the medical record audit portion of the CoVE PIM. Patient surveys will be distributed by the residency clinics. The goal will be to audit the medical records of patients who complete the patient survey. Residents in intervention groups will participate in completing the practice system survey as a group. Finally, the residents in the intervention group will use the data from the medical record audit, patient survey, and practice system survey, working with faculty, to develop a quality improvement project to improve care for their geriatric patients.

Local medical record abstractors will be trained to perform a separate medical record audit of a random sample of the same patients identified by the residents for both the intervention and comparison groups. The abstractors will perform both a baseline and follow-up audit and will target the same patients who are still living from the baseline period. The follow-up audit will occur 12 months after completion of the initial PIM data collection phase, or approximately 18 months after the initiation of the study.

Evaluation of study outcomes will occur on the program, resident, and patient level.

Conditions

Elderly

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Blinding Strategy: SINGLE

Study Groups

1

Control. Forty-two residency programs randomly assigned and stratified according to size, affiliation, geographic location, and presence of geriatrics fellowship. Twenty-one in the control arm. This group will use PIM as a data collection tool during baseline and follow-up time (i.e. audit of 50-75 charts, survey from 50-75 patients, and one system survey). They will not see the summary results of the data collected; they will not be required to complete a quality improvement plan based on the summary data. Local researchers will collect the data. Individual trainees will not do data collection or audits. At both baseline and follow-up, trainees will complete pre and post test surveys of 1) geriatric and 2) quality improvement knowledge, skills, and attitudes.

Group Type: ACTIVE_COMPARATOR

Geriatric and Quality Improvement toolkit

Intervention Type: OTHER

A resource toolkit about geriatrics and quality improvement was given to both study arms.

2

There are 21 residency programs in intervention arm who will 1) use PIM as a data collection tool (local researchers will audit 50-75 charts, survey 50-75 patients, and complete one system survey); 2) Each trainee will audit of up to five patient charts; collect 5 patient surveys; and complete the system survey as a group; 3) Summary data from these data streams will be reviewed by group; then they will design and implement a quality improvement plan; 4) At follow-up, local researchers will re-audit same 50-75 charts, collect surveys from same 50-75 patients, and complete one system survey. At baseline and follow-up, trainees and faculty will complete surveys of geriatric and quality improvement knowledge, skills, and attitudes.

Group Type: OTHER

ABIM Care of Vulnerable Elderly Practice Improvement Module

Intervention Type: OTHER

The ABIM CoVE PIM is a practice-performance self-evaluation instrument. It is a web-based tool based on nationally recognized guidelines that uses chart abstraction, patient surveys, and a practice system survey in order to generate a performance report focused on a key aspects of care for vulnerable elderly.

Geriatric and Quality Improvement toolkit

Intervention Type: OTHER

A resource toolkit about geriatrics and quality improvement was given to both study arms.

Interventions

ABIM Care of Vulnerable Elderly Practice Improvement Module

The ABIM CoVE PIM is a practice-performance self-evaluation instrument. It is a web-based tool based on nationally recognized guidelines that uses chart abstraction, patient surveys, and a practice system survey in order to generate a performance report focused on a key aspects of care for vulnerable elderly.

Intervention Type: OTHER

Geriatric and Quality Improvement toolkit

A resource toolkit about geriatrics and quality improvement was given to both study arms.

Intervention Type: OTHER

Other Intervention Names

Quality improvement module; Practice improvemnet module; Self-assesment in pratice based learning and improvement; PIM in residency; The Improvement Guide by Langley and Nolan; Geriatrics at Your Fingertips; ACOVE Physician Education Program DVD; Online resources; Membership to AGS teaching slides website

Eligibility Criteria

Inclusion Criteria

• All residents at a resident clinic site
• Preceptors that are selected by the Champion for a particular resident clinic site
• Patients age 65 years or older for whom any of the following measures would be appropriate: falls prevention, identifying urinary incontinence, screening for depression and cognitive impairment, and providing other preventive care.
• Patients who have been in the practice for at least one year
• Patients who are ambulatory
• Patients who have been seen at least once by the practice within the past 12 months.

Exclusion Criteria

• Patients under age 65
• Patients who have a terminal illness
• Patients with a life expectancy of less than one-year

• Minimum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

The Josiah Macy, Jr. Foundation

UNKNOWN

Sponsor Role: collaborator

American Board of Internal Medicine

OTHER

Sponsor Role: lead

Responsible Party

American Board of Internal Medicine

Principal Investigators

Eric S Holmboe, MD

Role: PRINCIPAL_INVESTIGATOR

American Board of Internal Medicine

Related Links

http://www.abim.org/

ABIM website. Please go to "Helpful Resources" under "Residency Training" to see more information about the CoVE PIM.

Other Identifiers

CPS 485

Identifier Type: -

Identifier Source: org_study_id