Systematic outpatient screening for the elderly: care of the vulnerable elderly practice improvement module to assess resident care of older adults.

摘要

OBJECTIVES: To determine the feasibility of using the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module (CoVE PIM) in an internal medicine residency program and to assess aggregate resident documentation of geriatric screening in continuity clinics. DESIGN: Needs assessment chart review for single-site pre-/postintervention study. SETTING: Internal medicine resident primary care continuity clinics. PARTICIPANTS: Thirty-seven postgraduate year (PGY)-1 and PGY-2 internal medicine residents. MEASUREMENTS: Completion rate and time of CoVE PIM chart review, CoVE PIM user difficulty, and aggregate percentage of charts documenting geriatric screening measures. RESULTS: Sixty-five percent of residents completed the CoVE PIM in an average of 47 minutes (range 30-90 minutes); 72% of resident surveys rated the CoVE PIM as easy to use. Residents demonstrated very good documentation of chronic medical conditions, smoking status, height, weight, and blood pressure and poor documentation of falls and fall risk, hearing assessment, postural hypotension, balance, rigidity, bradykinesia, home safety assessment, seat belt counseling, code status, and surrogate decision-maker. CONCLUSION: The CoVE PIM can be used to assess aggregate resident performance of geriatric screening measures. In resident clinics, general adult screening performed by nurses is well documented, whereas geriatric-specific screening performed by physicians is poorly documented.