ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue

ABIM Care of the Vulnerable Elderly PIM™
Practice Improvement Module
Measures Catalogue

Care of the Vulnerable Elderly PIM
Measures Catalogue
September 2010

TABLE OF CONTENTS

Introduction .............................................................................................................................................................. 3

Processes of Care.................................................................................................................................................... 5

Patient Experience: Outcomes of Care .............................................................................................................. 17

Patient Experience: Processes of Care ............................................................................................................. 18

Care of the Vulnerable Elderly Measure Catalog September 2010 Page 2 of 22

Introduction
This catalogue provides information related to the American Board of Internal Medicine’s Care of the Vulnerable Elderly
Practice Improvement Module®. It is written in language that addresses the physician who might choose to complete this
module, and it details the specifics of the module. Included is information regarding:

• Purpose and structuring of the module
• Patient inclusion criteria
• Detailed description of the measures

This PIM examines the care you provide to your patients by addressing key processes and outcomes of care for older patients. These
are based primarily on guidelines from the American Geriatrics Society.

The PIM is divided into three parts, with multiple sections in each part.

Part 1 -Performance Data
Provide baseline data about your practice's current performance by...

• Surveying your patients
• Reviewing your charts
• Assessing your practice systems

The 17 patient survey measures and 44 chart review measures are summarized below. ABIM requires a minimum of 25 patient
surveys and 25 chart reviews. The practice systems assessment comprises questions covering various aspects of practice structure
and protocols.

Patients can be included in this module if all of the following are true:

1. They are at least 75 years old. If it is not feasible to identify 50 patients age 75 and older who meet the other
inclusion/exclusion criteria, you may include patients age 65 and older;
2. They have been patients in the practice for at least one year; AND
3. They have been seen by the practice within the past 12 months.


Patients should be excluded from this module if any of the following is true:

1. They are unable to complete the patient survey, even with assistance;
2. They are non-ambulatory;
3. They have severe cognitive impairment; OR
4. They have a terminal illness and life expectancy of less than one year.

Part 2 - Quality Improvement (QI) Plan
Develop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysis
will include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this quality
improvement (QI) cycle.

Part 3 - Remeasurement
Remeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect on
the process of developing and implementing a QI plan.

You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates this
educational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.


CARE OF THE VULNERABLE ELDERLY - PROCESSES OF CARE

History

Measure Title Description Numerator Denominator Rationale

Chronic Medical Conditions Percentage of questions in the Number of questions in the Number of possible
Chronic Medical Conditions Chronic Medical Conditions responses to the
section of the chart review for section of the chart review for questions in the
which "Yes" or "No" responses which "Yes" or "No" responses Chronic Medical
were given, indicating that the were given, indicating that the Conditions section
necessary information was necessary information was of the chart review
available to the physician; available to the physician;
questions asked about the questions asked about the
presence or absence of presence or absence of
diabetes, CHD, heart failure, diabetes, CHD, heart failure,
prior CVA, hypertension, prior CVA, hypertension,
arthritis that limits mobility or arthritis that limits mobility or
causes significant pain, prior hip causes significant pain, prior hip
fracture, osteoporosis, fracture, osteoporosis,
neuropathy, Parkinson's neuropathy, Parkinson's
disease, COPD, cognitive disease, COPD, cognitive
impairment, visual impairment, impairment, visual impairment,
and hearing impairment and hearing impairment
Patients in the sample who Number of patients in the
were reported as having sample who were reported as
cognitive impairment having cognitive impairment

Smoking status Patients in the sample whose Number of patients in the Number of patients The routine and thorough
current smoking status was sample whose current smoking in the sample assessment of tobacco use is
documented status was documented important as a means of
preventing smoking or
encouraging cessation.

Alcohol use Patients in the sample whose Number of patients in the Number of patients Elderly persons are at higher risk
current level of alcohol use was sample whose current level of in the sample for alcohol-related health
documented within the past 12 alcohol use was documented problems. This higher risk is due to
months within the past 12 months a lower tolerance to the effects of
alcohol; a higher likelihood of
using multiple medications; and a
higher likelihood of other physical
disabilities or frailty, including
slowed reaction times, impaired
vision, and hearing loss. After
drinking equal amounts of alcohol,


History


older adults have higher blood
alcohol levels than younger adults.
Excess use of alcohol by older
patients can increase the risk of
falls, worsen problems with
incontinence, and complicate
cognitive impairment. The National
Institute on Alcohol Abuse and
Alcoholism (NIAAA) recommends
that people over 65 limit
themselves to one drink daily.

Level of physical activity Patients in the sample whose Number of patients in the Number of patients Research supports the
current level of physical activity sample whose current level of in the sample recommendation that exercise
was documented within the past physical activity was (i.e., resistance/strength training;
12 months documented within the past 12 balance, gait, and co-ordination
months training) helps to reduce falls.

Mobility and functional Percentage of questions in the Number of questions in the Number of possible Mobility and functional status
status Mobility and Functional Status Mobility and Functional Status responses to the determine the ability to participate
sections of the chart review for sections of the chart review for Mobility and in daily activities, including self-
which "Yes" or "No" responses which "Yes" or "No" responses Functional Status care and social interaction. Any
were given, indicating that the were given, indicating that the questions in the change in mobility or functional
necessary information was necessary information was chart review status should prompt investigation
available to the physician; available to the physician; of etiology and consequences.
questions asked about the questions asked about the
patient's mobility status (ability patient's mobility status (ability
to climb a flight of stairs and to climb a flight of stairs and
walk 1/4 mile) and general walk 1/4 mile) and general
physical functional status physical functional status

Use of over-the-counter Patients in the sample whose Number of patients in the Number of patients Many older adults use over-the-
medications use of over-the-counter sample whose use of over-the- in the sample counter (OTC) medications, but
medications was documented counter medications was many patients do not inform their
documented physicians about their use.
Patients should be asked directly
about their use of such
medications. OTC drugs may be
harmful, of no benefit, or interact
with prescribed medications.


History


Use of Patients in the sample whose Number of patients in the Number of patients Many older adults use
complimentary/alternative use of sample whose use of in the sample complementary/alternative
medications complimentary/alternative complimentary/alternative medications (CAM), but many
medications was documented medications was documented patients do not inform their
physicians about their use.
Patients should be asked directly
about their use of CAM, which may
be harmful, of no benefit, or
interact with prescribed
medications.

Screening and Evaluation

Depression screen Patients in the sample reported Number of patients in the sample Number of patients Depression is common in older
within past 12 months as having had a screen for reported as having had a screen in the sample adults but also is under-recognized
depression within the past 12 for depression within the past 12 and under-treated. The risk of
months months depression is increased in patients
who have other illnesses and/or
functional limitations.

Cognitive impairment Patients in the sample reported Number of patients in the sample Number of patients A detailed evaluation of cognitive
screen within past 12 as having had a screening test reported as having had a in the sample, function is one element of a
months for cognitive impairment within screening test for cognitive excluding those with multifactorial assessment for fall
the past 12 months impairment within the past 12 a diagnosis of risk.
months cognitive impairment
(for whom screening
for cognitive
impairment,
therefore, is not
appropriate)

Falls-risk screen within Patients in the sample reported Number of patients in the sample Number of patients All older patients (or their
past 12 months as having had a screening for reported as having had a in the sample caregivers) should be asked at least
falls risk within the past 12 screening for falls risk within the once a year about falls, frequency
months past 12 months of falling, and difficulties in gait or
balance.

Urinary incontinence Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common in
screen reported as having had who were reported as having in the sample older adults, and its prevalence




screening for urinary had screening for urinary increases with age. Incontinence is
incontinence incontinence associated with other common
geriatric conditions, including prior
hysterectomy, obesity, prior stroke,
chronic obstructive pulmonary
disease, slow gait speed, and poor
overall health. It has a significant
negative impact on self-esteem and
quality of life; incontinence also is a
risk factor for depression, falls, and
nursing home placement. Surgical,
medical, and behavioral treatments
vary with the etiology; while not all
patients will be interested in
exploring treatment options, all can
benefit from advice on managing
the condition.

Vision testing within Patients in the sample who were Number of patients in the sample Number of patients Aging is associated with changes in
past 24 months - reported as having had a vision who were reported as having in the sample visual acuity, development of
ChRvw test within the past 24 months had a vision test within the past cataracts, macular degeneration,
24 months glaucoma, and other conditions.

Physical Examination


Weight Patients in the sample with Number of patients in the sample Number of patients Measuring body weight over time is
weight documented who have weight documented in the sample a simple screen for nutritional
adequacy and change in older
adults. Nonvolitional weight loss
may be predictive of mortality.

Height Patients in the sample with Number of patients in the sample Number of patients Studies have shown that height loss
height documented who have height documented in the sample increases the likelihood of
osteoporosis of the hip and
increases with the amount of height
lost.

Blood pressure Patients in the sample whose Number of patients in the sample Number of patients The detection and treatment of high
blood pressure whose blood pressure in the sample blood pressure can reduce the risk




(systolic/diastolic) was measured (systolic/diastolic) was measured of morbidity and mortality from
during the specified abstraction coronary heart disease, stroke, and
period (within 12 months of the chronic kidney disease.
visit date, with a three-month
grace period), with date and
value of the measurement
documented
Postural hypotension Patients in the sample who were Number of patients in the sample Number of patients Postural hypotension has been
assessment within past reported as having had a who were reported as having in the sample associated with an increased risk of
12 months postural hypotension had a postural hypotension falls.
assessment within the past 12 assessment within the past 12
months months

Gait evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance
reported as having had a gait who were reported as having in the sample should be evaluated in older
evaluation had a gait evaluation patients, particularly those who
have had a fall. This evaluation can
serve as a screening tool to identify
patients who may need
multifactorial fall-risk assessment or
as a component of such an
assessment.

Balance evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance
reported as having had a who were reported as having in the sample should be evaluated in older
balance evaluation had a balance evaluation patients, particularly those who
have had a fall. This evaluation can
serve as a screening tool to identify
patients who may need
multifactorial fall-risk assessment or
assessment.

Quadriceps strength Patients in the sample who were Number of patients in the sample Number of patients Testing of muscle strength in the
testing reported as having had who were reported as having in the sample lower extremities is one element of
quadriceps strength testing had quadriceps strength testing a multifactorial assessment for fall
risk.

Testing for rigidity Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular
(cogwheeling) reported as having had testing who were reported as having in the sample examination is one element of a
for rigidity (cogwheeling) had testing for rigidity multifactorial assessment for fall




(cogwheeling) risk. Parkinson's disease is
associated with an increased risk
for falls.
Testing for bradykinesia Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular
reported as having had testing who were reported as having in the sample examination is one element of a
for bradykinesia had testing for bradykinesia multifactorial assessment for fall
risk. Parkinson's disease is
associated with an increased risk
for falls.

Assessments and Treatments – Falls, Problems with Walking, Balance

Circumstances of fall Patients in the sample who were Number of patients in the sample Number of patients It is important to have a detailed
documented reported as having fallen within who were reported as having in the sample who description of the circumstances of
the past 12 months and for fallen within the past 12 months were reported as falls, including frequency, symptoms
whom the circumstances of the and for whom the circumstances having fallen within at the time of the event, injuries,
fall were completely documented of the fall were completely the past 12 months and other consequences.
documented

Gait evaluation done Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance
reported as either having fallen who were reported as either in the sample who should be evaluated in older
or as having a fear of falling having fallen or as having a fear were reported as patients, particularly those who
during the past 12 months and of falling during the past 12 either having fallen have had a fall. This evaluation can
for whom a gait evaluation was months and for whom a gait or as having a fear serve as a screening tool to identify
done evaluation was done of falling during the patients who may need
past 12 months multifactorial fall-risk assessment or
assessment.

Balance evaluation Patients in the sample who were Number of patients in the sample Number of patients Problems with gait and/or balance
done reported as either having fallen who were reported as either in the sample who should be evaluated in older
or as having a fear of falling having fallen or as having a fear were reported as patients, particularly those who
during the past 12 months and of falling during the past 12 either having fallen have had a fall. This evaluation can
for whom a balance evaluation months and for whom a balance or as having a fear serve as a screening tool to identify
was done evaluation was done of falling during the patients who may need
past 12 months multifactorial fall-risk assessment or
assessment.




Quadriceps strength Patients in the sample who were Number of patients in the sample Number of patients Testing of muscle strength in the
testing done reported as either having fallen who were reported as either in the sample who lower extremities is one element of
or as having a fear of falling having fallen or as having a fear were reported as a multifactorial assessment for fall
during the past 12 months and of falling during the past 12 either having fallen risk.
for whom quadriceps strength months and for whom or as having a fear
testing was done quadriceps strength testing was of falling during the
done past 12 months
Testing for rigidity Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular
(cogwheeling) done reported as either having fallen who were reported as either in the sample who examination is one element of a
or as having a fear of falling having fallen or as having a fear were reported as multifactorial assessment for fall
during the past 12 months and of falling during the past 12 either having fallen risk. Parkinson's disease is
for whom testing for rigidity months and for whom testing for or as having a fear associated with an increased risk
(cogwheeling) was done rigidity (cogwheeling) was done of falling during the for falls.
past 12 months

Testing for bradykinesia Patients in the sample who were Number of patients in the sample Number of patients A detailed neuromuscular
done reported as either having fallen who were reported as either in the sample who examination is one element of a
or as having a fear of falling having fallen or as having a fear were reported as multifactorial assessment for fall
during the past 12 months and of falling during the past 12 either having fallen risk. Parkinson's disease is
for whom testing for bradykinesia months and for whom testing for or as having a fear associated with an increased risk
was done bradykinesia was done of falling during the for falls.
past 12 months

Physical Patients in the sample who were Number of patients in the sample Number of patients Physical therapy interventions,
therapy/rehabilitation reported as either having fallen who were reported as either in the sample who including gait training, progressive
referral made or as having a fear of falling having fallen or as having a fear were reported as balance exercises, and home
during the past 12 months and of falling during the past 12 either having fallen evaluation for environmental
for whom a referral for physical months and for whom a referral or as having a fear hazards, may be indicated for
therapy or rehabilitation was for physical therapy or of falling during the patients who have a history of, or at
made rehabilitation was made past 12 months risk for, falls. Assistive devices also
may be useful for some patients.

Medication review done Patients in the sample who were Number of patients in the sample Number of patients Medications are an important and
reported as either having fallen who were reported as either in the sample who modifiable risk factor for falls.
or as having a fear of falling having fallen or as having a fear were reported as Several drugs that act upon the
during the past 12 months and of falling during the past 12 either having fallen central nervous system have been
for whom a medication review months and for whom a or as having a fear associated with increased fall risk,
was done, addressing an medication review was done, of falling during the including antidepressants,
important and reversible risk addressing an important and past 12 months benzodiazepines, neuroleptics, and
factor for falls reversible risk factor for falls antiepileptics. Vasodilators also are




linked with increased fall risk. A
recent change in the dosage of a
medication and the total number of
medications prescribed also appear
to increase the risk of falling.

Home-safety Patients in the sample who were Number of patients in the sample Number of patients Home-safety questionnaires can
assessment done reported as either having fallen who were reported as either in the sample who help patients and their caregivers
or as having a fear of falling having fallen or as having a fear were reported as identify risks for falls within the
during the past 12 months and of falling during the past 12 either having fallen home. If safety issues are identified
for whom a home safety months and for whom a home- or as having a fear that cannot be readily addressed by
assessment was done or safety assessment was done or of falling during the the patient, consider referring the
arranged arranged past 12 months patient to the local Area Agency on
Aging.

Assessments and Treatments – Urinary Incontinence


Urinary incontinence Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common in
bothersome enough to reported as having urinary who were reported as having in the sample who older adults, and its prevalence
ask about treatment incontinence and for whom the urinary incontinence and for were reported as increases with age. Incontinence is
condition was bothersome whom the condition was having urinary associated with other common
enough for the patient to ask bothersome enough for the incontinence geriatric conditions, including prior
about treatment options patient to ask about treatment hysterectomy, obesity, prior stroke,
options chronic obstructive pulmonary
the condition.

Evaluation/treatment for Patients in the sample who were Number of patients in the sample Number of patients Urinary incontinence is common in
bothersome urinary reported as having bothersome who were reported as having in the sample who older adults, and its prevalence


Assessments and Treatments – Urinary Incontinence


incontinence - ChRvw urine leakage and who received bothersome urine leakage and were reported as increases with age. Incontinence is
evaluation or treatment for it who received evaluation or having bothersome associated with other common
treatment for it urine leakage geriatric conditions, including prior
hysterectomy, obesity, prior stroke,
the condition.

Preventive Care


Influenza vaccine during Patients in the sample Number of patients in the Number of patients in Influenza is a common, preventable
the most recent flu season who were reported as sample who were the sample infectious disease associated with high
having received influenza reported as having mortality and morbidity in the elderly and in
vaccine during the most received influenza vaccine people with chronic diseases.
recent flu season during the most recent flu
season

Pneumococcal vaccine Patients in the sample Number of patients in the Number of patients in Pneumonia is a common, preventable
who were reported as sample who were the sample infectious disease associated with high
having received reported as having mortality and morbidity in the elderly and in
pneumococcal vaccine received pneumococcal people with chronic diseases.
vaccine

Zoster vaccine Patients in the sample Number of patients in the Number of patients in Herpes zoster infection is common in older
who were reported as sample who were the sample adults, as is the complication of
having received zoster reported as having postherpetic neuralgia. Vaccination is
vaccine received zoster vaccine recommended for all adults age 65 and
older, regardless of their history of prior
zoster infection.


Preventive Care


Bone-mineral density Female patients in the Number of female patients Number of female Bone mineral density correlates with bone
screening for women sample who have in the sample who have patients in the sample strength and is an excellent predictor of
received bone-density received bone-density future fracture risk. The National
screening screening Osteoporosis Foundation recommends
screening for women age 65 and older,
regardless of other risk factors.

Bone-mineral density Male patients age 70 and Number of male patients Number of male patients Bone mineral density correlates with bone
screening for men age 70 older in the sample who age 70 and older in the age 70 and older in the strength and is an excellent predictor of
and older have received bone- sample who have sample future fracture risk. The National
density screening received bone-density Osteoporosis Foundation recommends
screening screening for men age 70 and older,
regardless of other risk factors.
Home-safety checklist Patients in the sample Number of patients in the Number of patients in Home-safety questionnaires can help
who were reported as sample who were reported the sample patients and their caregivers identify risks
having received a home- as having received a for falls within the home.
safety checklist home-safety checklist
Advice to limit alcohol Patients in the sample Number of patients in the Number of patients in Elderly persons are at higher risk for
consumption who were reported to sample who were the sample reported to alcohol-related health problems. This
engage in potentially reported to engage in engage in excessive higher risk is due to a lower tolerance to the
hazardous drinking and potentially hazardous alcohol consumption effects of alcohol; a higher likelihood of
who have been advised to drinking and who have using multiple medications; and a higher
limit their alcohol been advised to limit their likelihood of other physical disabilities or
consumption alcohol consumption frailty, including slowed reaction times,
impaired vision, and hearing loss. After
drinking equal amounts of alcohol, older
adults have higher blood alcohol levels
than younger adults. Excess use of alcohol
by older patients can increase the risk of
falls, worsen problems with incontinence,
and complicate cognitive impairment.
Excess use of alcohol by older patients can
increase the risk of falls, worsen problems
with incontinence, and complicate cognitive
impairment. The National Institute on
Alcohol Abuse and Alcoholism (NIAAA)
recommends that people over 65 limit
themselves to one drink daily.

Advice to start, increase, Patients in the sample Number of patients in the Number of patients in Research supports the recommendation


Preventive Care


or maintain exercise who were advised to start, sample who were advised the sample that exercise (i.e., resistance/strength
program - ChRvw increase, or maintain to start, increase, or training; balance, gait, and co-ordination
participation in an maintain participation in training) helps to reduce falls.
exercise program that an exercise program that
includes attention to includes attention to
balance and strength balance and strength

Smoking-cessation Current smokers in the Number of current Number of current A number of large randomized clinical trials
counseling sample documented to smokers in the sample smokers in the sample have demonstrated the efficacy and cost-
have received smoking- documented to have effectiveness of smoking-cessation
cessation counseling received smoking- counseling in changing smoking behavior
during the 12-month cessation counseling and reducing tobacco use.
period prior to the index during the 12-month
visit, with a three-month period prior to the index
grace period visit, with a three-month
grace period

End-of-Life-Care
Patient's preferences Patients in the sample whose Number of patients in the sample Number of patients Physicians routinely should discuss
for life-sustaining care preferences for life-sustaining whose preferences for life- in the sample life-sustaining treatment decisions
are documented care were documented sustaining care were with their patients, particularly
documented before the actual need for such care
arises. Patients should be asked to
designate a surrogate decision
maker and to discuss their
preferences with this person and
with other family members and
friends.
Patient's designated Patients in the sample whose Number of patients in the sample Number of patients Physicians routinely should discuss
surrogate decision designated surrogate decision whose designated surrogate in the sample life-sustaining treatment decisions
maker is documented maker was documented decision maker was documented with their patients, particularly
before the actual need for such care
arises. Patients should be asked to
designate a surrogate decision
maker and to discuss their
preferences with this person and
with other family members and
friends.


Other Assessments


Hearing assessment Patients in the sample Number of patients in the Number of patients in Hearing loss is associated with depression
who were reported as sample who were the sample and decreased quality of life; it also can be
having had a hearing reported as having had a mistaken for confusion or poor cooperation
assessment within the hearing assessment in older adults.
past 12 months within the past 12 months


PATIENT EXPERIENCE: CARE OF THE VULNERABLE ELDERLY – OUTCOMES OF CARE

Patient Satisfaction


Patient rates care of Patients in the sample who Number of patients in the sample Number of patients Patient satisfaction is both an
older adults “excellent” responded “Excellent” to the who responded “Excellent” to the who completed a indicator of quality of care and a
question regarding care of older survey question “How is this survey component of quality care. When
patients doctor’s office at taking care of individual needs are perceived as
older patients?” being met, better care results.

Patient would Patients in the sample who Number of patients in the sample Number of patients Patient satisfaction is both an
recommend practice to reported that they would who reported that they would who completed a indicator of quality of care and a
other older adults recommend this practice to other recommend this practice to other survey component of quality care.
older adults older adults


PATIENT EXPERIENCE: CARE OF THE VULNERABLE ELDERLY – PROCESSES OF CARE



Vision testing within Patients in the sample who Number of patients in the sample Number of patients Aging is associated with changes in
past 24 months - PtSrv reported having had their vision who reported having had their who completed a visual acuity, development of
checked within the past two vision checked within the past survey cataracts, macular degeneration,
years two years glaucoma, and other conditions.

Preventive Care


Smoking cessation Patients in the sample who Number of patients in this Number of surveyed
counseling - PtSrv responded "Yes, more than sample who responded "Yes, patients that are
once" to the survey question "If more than once" to the survey smokers
you smoke, has your doctor question "If you smoke, has your
advised you to stop?" doctor advised you to stop?"

Physical Activity


Patient asked about Patients in the sample who Number of patients in the sample Number of patients Research supports the
level of physical activity reported being asked about level who reported being asked about who completed a recommendation that exercise (i.e.,
of physical activity level of physical activity survey resistance/strength training;
balance, gait, and co-ordination
training) helps to reduce falls.

Advice to start, Patients in the sample who Number of patients in the sample Number of patients Research supports the
increase, or maintain reported receiving advice to who reported receiving advice to who completed a recommendation that exercise (i.e.,
exercise program - start, increase, or maintain start, increase, or maintain survey resistance/strength training;
PtSrv participation in an exercise participation in an exercise balance, gait, and co-ordination
program that includes attention program that includes attention training) helps to reduce falls.
to balance and strength to balance and strength


Assessments
Patient asked about Patients in the sample who Number of patients in the sample Number of patients Hearing loss is associated with
hearing problems reported that their doctor or who reported that their doctor or who completed a depression and decreased quality of
someone in the office asked if someone in the office asked if survey life; it also can be mistaken for
they had any problems with their they had any problems with their confusion or poor cooperation in
hearing hearing older adults.
Patient asked about Patients in the sample who Number of patients in the sample Number of patients Some loss of recent memory occurs
memory concerns reported that their doctor or who reported that their doctor or who completed a in many older adults and generally
someone in the doctor's office someone in the doctor's office survey is benign. However, memory loss
asked if they had any concerns asked if they had any concerns that affects daily living should be
about memory about memory evaluated carefully. Older adults
may be aware of and concerned
about subjective memory
impairment, which is a risk factor for
progression to dementia. Other
causes of memory loss include
depression, drug and alcohol
effects, stroke, and head injury;
some of these causes may be
reversible.
Patient has discussed Patients in the sample who Number of patients in the sample Number of patients All older patients (or their
falls with doctor or reported having fallen during the who reported having fallen who completed a caregivers) should be asked at least
someone in the office past 12 months and who spoke during the past 12 months and survey and who once a year about falls, frequency of
with their doctor or someone in who spoke with their doctor or reported having falling, and difficulties in gait or
the office about falling someone in the office about fallen during the past balance.
falling 12 months
Patient has discussed Patients in the sample who Number of patients in the sample Number of patients Problems with gait and/or balance
problems with reported having had a problem who reported having had a in the sample who should be evaluated in older
balance/walking with with balance or walking during problem with balance or walking reported having had patients, particularly those who
doctor or someone in the past 12 months and who during the past 12 months and a problem with have had a fall.
the office spoke with the doctor or who spoke with the doctor or balance or walking
someone in the doctor's office someone in the doctor's office during the past 12
about the problem about the problem months
Patient advised about Patients in the sample who Number of patients in the sample Number of patients A variety of interventions have been
how to prevent falls reported having been advised who reported having been who completed a used to prevent falls in older adults.
about how to prevent falls advised about how to prevent survey The most effective interventions are
falls multicomponent, including exercise
and education, and targeted to the
individual patient.


Urinary Incontinence


Patient has bothersome Patients in the sample who Number of patients in the sample Number of patients Urinary incontinence is common in
urinary incontinence reported having bothersome who reported having bothersome in the sample who older adults, and its prevalence
and has discussed it urine leakage and who reported urine leakage and who reported reported having increases with age. Incontinence is
with doctor or someone speaking with the doctor or speaking with the doctor bothersome urine associated with other common
in the office someone in the office about the someone in the office about the leakage (i.e., geriatric conditions, including prior
problem problem answered "A big hysterectomy, obesity, prior stroke,
problem" or "A small chronic obstructive pulmonary
problem" to the disease, slow gait speed, and poor
survey question overall health. It has a significant
"How much of a negative impact on self-esteem and
problem, if any, was quality of life; incontinence also is a
the urine leakage for risk factor for depression, falls, and
you?") nursing home placement. Surgical,
the condition.

Evaluation/treatment for Patients in the sample who Number of patients in the sample Number of patients Urinary incontinence is common in
bothersome urinary reported having bothersome who reported having bothersome in the sample whose older adults, and its prevalence
incontinence - PtSrv urine leakage and who reported urine leakage and who reported incontinence was increases with age. Incontinence is
receiving evaluation or treatment receiving evaluation or treatment bothersome enough associated with other common
for it for it to ask about geriatric conditions, including prior
treatment options hysterectomy, obesity, prior stroke,
the condition.


Physician/Practice Communications


Doctor rated "excellent" Patients in the sample who rated Number of patients in the Number of patients Care should be patient-centered,
at encouraging/ the doctor "Excellent" at sample who responded who completed a respectful of and responsive to
answering questions encouraging/answering “Excellent” to the survey survey, excluding individual patient preferences,
clearly questions clearly question "How is this doctor at those who needs, and values and ensuring
encouraging you to ask responded "Not that patient values guide all clinical
questions and answering them applicable" to the decisions. Patients' overall
clearly?" question "How is experiences with doctors are
this doctor at shaped by communication style
encouraging you to and content; both contribute to the
ask questions and likelihood that a patient will
answering them understand and be able to follow
clearly?" treatment recommendations.

Staff rated "excellent" at Patients in the sample who rated Number of patients in the Number of patients Care should be patient-centered;
encouraging/answering the staff "Excellent" at sample who responded who completed a respectful of and responsive to
questions encouraging/answering "Excellent" to the survey survey individual patient preferences,
questions clearly question "How is this doctor's needs, and values; and ensuring
staff at encouraging you to ask that patient values guide all clinical
questions and answering them decisions. Patients' overall
clearly?" experiences with a practice are
shaped by communication style
and content not only of the doctor,
but also of the practice staff; these
factors contribute to the likelihood
that a patient will understand and
be able to follow treatment
recommendations.

Doctor and staff rated Patients in the sample who rated Number of patients in the Number of patients Patients' overall experiences with
"excellent" at providing the practice "Excellent" at sample who responded who completed a doctors are shaped by
information on taking providing information on taking “Excellent” to the survey survey, excluding communication style and content;
medications properly medications properly question "How is this practice at those who both contribute to the likelihood that
making sure you have the responded "Not a patient will understand and be
information you need to take applicable" to the able to follow treatment
your medications properly?" question "How is recommendations. Helping patients
this practice at understand their medications, both
making sure you prescription and over-the-counter
have the information drugs, is an essential part of health
you need to take care.
your medications


Physician/Practice Communications


properly?"
Doctor and staff rated Patients in the sample who rated Number of patients who Number of patients Patients' overall experiences with
"excellent" at providing the practice "Excellent" at responded "Excellent" to the who completed a doctors are shaped by
information on providing information on survey question "How is this survey, excluding communication style and content;
medication side effects medication side effects practice at giving you those who both contribute to the likelihood that
information about side effects of responded "Not a patient will understand and be
your medications?" applicable" to the able to follow treatment
question "How is recommendations. Helping patients
this practice at understand their medications,
giving you including potential side effects, is
information about an essential part of health care.
side effects of your
medications?"

© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction or
adaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.


ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue

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ABIM Care of the Vulnerable Elderly PIM™ Practice Improvement Module Measures Catalogue