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Title page for ETD etd-03232012-141305


Type of Document Dissertation
Author Maxwell, Cathy A.
Author's Email Address cathy.maxwell@vanderbilt.edu
URN etd-03232012-141305
Title Administratively-Mediated Variables and Outcomes of Hospitalized Injured Older Adults
Degree PhD
Department Nursing Science
Advisory Committee
Advisor Name Title
Lorraine C. Mion Committee Chair
Ann Minnick Committee Member
Mary S. Dietrich Committee Member
William F. Fallon Committee Member
Keywords
  • geriatric trauma
  • injury
  • hospitalized elders
  • injured older adults
  • ACOVE indicators
  • elders
Date of Defense 2012-03-14
Availability unrestricted
Abstract
This dissertation study examined hospital structures and processes associated with outcomes among hospitalized injured older adults (HIOA). The Minnick and Roberts Outcomes Production Model guided the design of a study that examined: 1) presence of geriatric-specific quality indicators in acute care hospitals that provide care to HIOAs; 2) associations among mutable organizational factors and adoption of quality indicators; and 3) the extent to which mutable organization factors, including geriatric-specific quality indicators explained variations in one adverse event (deep vein thrombosis [DVT] or pulmonary embolus [PE]) in HIOAs. Findings indicate that adoption of geriatric-specific quality indicators remains low. Factors associated with adoption of quality indicators included computerized support for clinical decision-making and comprehensive geriatric assessment. In a final regression model that represented four levels of hypothesized influence, after controlling for the influence of all other variables, the strongest adjusted associations with rates of DVT or PE were for comorbidities, and hospitals with simulated home and community rehabilitation environments. Despite ten years of efforts promoting adoption of geriatric-specific quality indicators, much progress remains to be made. The occurrence of DVT/PE in HIOAs remains a problem. Postoperative thromboembolism must be carefully considered as a quality indicator.
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