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A comparison of the quality of care for elderly patients by practicing physicians or in internal or family medicine residency programs in the United States.

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Lynn LA, Conforti LN, Hess BJ, Arnold GK, Weng W, Lipner RS, Holmboe ES. — American Board of Internal Medicine

Presented: Association of Medical Education in Europe Conference, September 2008

Background: Physicians and health care systems need to be prepared to provide services known to decrease morbidity and improve quality of life for an aging population.

Work Done: The Care of Vulnerable Elderly Practice Improvement Module (CoVE PIM) is a Web-based tool using chart abstraction, patient surveys and a practice-system survey to generate performance reports focused on key aspects of care for patients >75. Performance of 134 practicing internists and geriatricians (3,442 patients) and trainees in 54 internal and family medicine U.S. residency programs (2,259 patients) is compared.

Patients under training program care were less likely to be screened for cognitive impairment (12% versus 55% for practicing physicians), falls risk (17% versus 62%), urinary incontinence (52% versus 94%) and hearing loss (14% versus 43%). Similar gaps exist for follow-up of falls and incontinence, functional status assessment, and addressing end-of-life preferences.

Conclusion: Health care services specific to elderly patients are often not provided. Quality gaps are significantly pronounced in training programs, raising serious questions about current training models in geriatrics for residents.

Take-Home Message: Care for elderly patients in training programs is poor. Improvement depends on improving practice systems and training faculty to facilitate acquisition of essential knowledge, skills and attitudes.

For more information about this presentation, please contact Research@abim.org.