Callahan Kathryn E, Wilson Lindsay A, Pavon Juliessa M, Lovato James F, Atkinson Hal H, Busby-Whitehead Jan, Dalton Thomas, Heflin Mitchell T, Iverson Patricia, Lawlor Janice S, Marsden Justin, Moran William P, Roberts Ellen, Williamson Jeff D
J Grad Med Educ. 2017 Jun;9(3):338-344. doi: 10.4300/JGME-D-16-00428.1.
Adults aged 65 years and older account for more than 33% of annual visits to internal medicine (IM) generalists and specialists. Geriatrics experiences are not standardized for IM residents. Data are lacking on IM residents' continuity experiences with older adults and competencies relevant to their care.
To explore patient demographics and the prevalence of common geriatric conditions in IM residents' continuity clinics.
We collected data on age and sex for all IM residents' active clinic patients during 2011-2012. Academic site continuity panels for 351 IM residents were drawn from 4 academic medical center sites. Common geriatric conditions, defined by Assessing Care of Vulnerable Elders measures and the American Geriatrics Society IM geriatrics competencies, were identified through International Classification of Disease, ninth edition, coded electronic problem lists for residents' patients aged 65 years and older and cross-checked by audit of 20% of patients' charts across 1 year.
Patient panels for 351 IM residents (of a possible 411, 85%) were reviewed. Older adults made up 21% of patients in IM residents' panels (range, 14%-28%); patients ≥ 75 (8%) or 85 (2%) years old were relatively rare. Concordance between electronic problem lists and chart audit was poor for most core geriatric conditions. On chart audit, active management of core geriatric conditions was variable: for example, memory loss (10%-25%), falls/gait abnormality (26%-42%), and osteoporosis (11%-35%).
The IM residents' exposure to core geriatric conditions and management of older adults was variable across 4 academic medical center sites and often lower than anticipated in community practice.
65岁及以上的成年人占每年内科（IM）全科医生和专科医生门诊量的33%以上。老年医学经验在IM住院医师中未标准化。缺乏关于IM住院医师与老年人连续性经验及其护理相关能力的数据。
探讨IM住院医师连续性诊所中患者的人口统计学特征和常见老年疾病的患病率。
我们收集了2011 - 2012年期间所有IM住院医师门诊活跃患者的年龄和性别数据。351名IM住院医师的学术机构连续性患者组来自4个学术医疗中心。根据脆弱老年人护理评估措施和美国老年医学会IM老年医学能力定义的常见老年疾病，通过国际疾病分类第九版，对65岁及以上住院医师患者的编码电子问题清单进行识别，并通过对1年中20%患者病历的审核进行交叉核对。
对351名IM住院医师（可能的411名中的85%）的患者组进行了审查。老年人占IM住院医师患者组的21%（范围为14% - 28%）；75岁及以上（8%）或85岁及以上（2%）的患者相对较少。对于大多数核心老年疾病，电子问题清单与病历审核之间的一致性较差。在病历审核中，核心老年疾病的积极管理情况各不相同：例如，记忆力减退（10% - 25%）、跌倒/步态异常（26% - 42%）和骨质疏松症（11% - 35%）。
在4个学术医疗中心，IM住院医师接触核心老年疾病和管理老年人的情况各不相同，且通常低于社区实践中的预期。
