Integrating Geriatric Medicine into Family Medicine Training: Developing a Geriatric Health Care Maintenance Report Card

Background With a growing aging population, PCPs are expected to be competent in the delivery of geriatric care. Literature shows evidence has of ACOVE quality indicators for vulnerable elders. Current ambulatory practice does not reflect these standards.

Methodology A GHMRC was developed incorporating elements of Comprehensive Geriatric Assessment (CGA), Preventive Maintenance (PM) standards. A random sample of 100 medical records of patients 65 and over were selected. A PGY 3 educated 10 PGY1s on ACOVE CGA and PM standards. Over 3 hours, 10 PGY1s used the tool for a chart review. Small group discussion followed to explore strengths and weaknesses of the tool. Descriptive quantitative analysis and qualtitative analysis followed.

Results All reviewers found the tool to be an organized, clear, quick reference of appropriate care in the elderly. Chart review Results showed significantly higher screening rates in the PM domains when compared to CGA. Alcohol, tobacco, CRC, breast ca screening rates were performed 38%, 78%, 57% and 33% respectively. Whereas only 7-10% of patients were screened for cognition or affect. Medication review was performed in 56% of cases but did not address polypharmacy or inappropriate use in the elderly.

Conclusions Although reviewers expressed the utility of a GHCM report- card further correlation with current forms of medical record QI forms may me indicated to integrate successfully into ambulatory practice.