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Improving falls-risk screening for older patients in residency outpatient clinics.


Holmboe ES, Conforti LN, Lynn LA, Hess BJ. — American Board of Internal Medicine

Presented: Association of Medical Education in Europe Conference, September 2009

Background: Residents must demonstrate effective care for older adults upon completion of training.

Work Done: Using a Web-based assessment tool called the Care of Vulnerable Elderly Practice Improvement Module (CoVE PIM), 11 internal medicine and family medicine residency clinics focused on improving fall-risk screening. Performance was compared with 22 control clinics and nine CoVE PIM intervention clinics that focused on a different quality measure.

In the 11 clinics, the screening rate improved from 10.4% (baseline) to 34.7% (follow-up) - Δ = 24.3% (OR, 2.13; 95% CI, 1.82-2.50), while the 22 control clinics only increased from 12.4% to 21.6% - Δ = 9.2% (OR, 1.41; 95% CI, 1.26-1.57). The other nine CoVE PIM intervention clinics also saw more improvement, but less than clinics targeting fall-risk screening (19.3% to 38.3%) - Δ = 18.9% (OR, 1.66; 95% CI, 1.42-1.94), despite starting at a higher baseline rate. Difference in Δ values was significant (χ2 = 7.00, p < .05).

Conclusion: The CoVE PIM helps residency clinics improve fall-risk screening for older patients, but performance remains suboptimal. Major challenges remain to prepare the future physician workforce to care for older patients.

Take-Home Message:A Web-based multifaceted assessment tool can improve the care for older patients.

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