TOTAL QUALITY MANAGEMENT AND GERIATRIC CARE

For numerous reasons it is essential that geriatric practitioners beco me involved in improving the care delivered to older patients in all c linical settings. One of the more promising approaches to enhancing ca re for older persons is the set of techniques and philosophy embodied in the Total Quality Management (TQM) method. To develop an agenda for improving the quality of care delivered to older persons, we surveyed over 1,600 geriatric practitioners and asked 38 experts in geriatric care and quality improvement (QI) to respond to a series of questionna ires. Findings resulted in suggested approaches to improving care in f our delivery sites (office, home, acute hospital nursing home). Of not e, the experts strongly favoured the newer QI methods such as TQM. ove r traditional approaches such as Medicare Review and Minimum Data Set. Potential next steps to improve QI methods in geriatric care are outl ined, use of TQM in office practice and nursing homes is reviewed, and examples of successful TQM programs in these settings are described.