ACOVE quality indicators may improve care in hospitalized elderly

Clinicians administered a checklist during rounds, which assessed for prophylaxis against venous thromboembolism, indwelling bladder catheters, mobilization, and delirium evaluation—four commonly encountered components of Assessing Care of Vulnerable Elders (ACOVE).

Assessing Care of Vulnerable Elders (ACOVE) quality indicators may be used to improve care in hospitalized elderly adults, according to a recent study.

Researchers at a U.S. hospital performed a prospective interventional study in hospitalized patients ages 75 years and older who were admitted to medical units from May 1, 2014, to June 30, 2015. A nonequivalent retrospective group of patients was used as the control group. For the intervention, a checklist evaluating four ACOVE quality indicators, those most commonly encountered in the hospital, was administered during interdisciplinary daily rounds:

  • prophylaxis against venous thromboembolism (VTE),
  • indwelling bladder catheters,
  • mobilization, and
  • delirium evaluation.

Quality indicator compliance was the primary outcome; length of stay, discharge disposition, and readmissions were secondary outcomes. Compliance rates for the intervention and control groups were estimated during the postintervention period. The study results were published in the July Journal of Hospital Medicine.

A total of 2,396 patient admissions were included in the study, and of these, 530 were on the intervention unit and 1,886 were on the control units. The average age of each group was about 85 years, and about 75% of patients in each group were white. Adherence to the VTE measure was 78.3% in the intervention group and 76.5% in the control group overall. Among the 554 patients whose care was not already adherent to the measure before the intervention, these rates were 57% versus 39%, respectively (P<0.0056). Overall compliance rates for the other three quality indicators were 72.2% in the intervention group versus 54.4% in the control group for indwelling catheters (P=0.1061), 62.9% versus 48.2% for mobilization (P<0.0001), and 27.9% versus 21.7% for delirium evaluation (P=0.0027). No statistically significant differences were seen between the intervention and control groups for any of the secondary outcomes.

The authors acknowledged that their study used data from only one hospital and therefore may not be generalizable. In addition, they noted that compliance rates for delirium evaluation were especially low and may not have been captured correctly by the medical record, since validated delirium measures are not currently documented in their electronic health record. However, they concluded that ACOVE quality indicators can be successfully integrated into clinical practice as an intervention instead of an assessment method and noted that using a checklist at the bedside can improve implementation of standardized care.

“This innovative approach provides a much-needed direction to healthcare providers in the ever increasing stressful conditions of today's acute care environment and for the ultimate benefit and safety of our older patients,” the authors wrote.