First, the project team retrieved quality indicator data from recently published synthesis conferences on quality indicators for each of the selected conditions. A Task Force on Aging with members from the American College of Physicians and the American Society of Internal Medicine recently published a set of manuscripts concerning the assessment of quality of care for older persons, a project entitled "Assessing Care of Vulnerable Elders" (ACOVE).37 Among the goals of the project was to develop a set of evidence-based, quality of care indicators relevant to vulnerable older persons, and to design a chart abstraction tool, interview instruments, and data analytic methods to implement a quality-of-care indicator system. Three of the manuscripts specifically addressed quality indicators for the domains of pain management, pressure ulcers, and urinary incontinence.32, 34, 36 Efforts that summarize the essential literature in specific areas, like the ACOVE initiative, are important for terminology work because they represent consensus among experts in the field on the key terms and concepts relevant to the knowledge base required for specific domains.
Although the ACOVE project focused on the identification of high-risk, community dwelling older persons, we chose to include the data elements put forward in these manuscripts for several reasons. First and most important for our purposes, there was a deliberate effort to develop the quality indicators considering information typically available in the medical record and administrative data. Second, each focused area included aspects of prevention, diagnosis, treatment and follow-up. Finally, the indicators were specifically developed for use in assessing the processes of care delivered to vulnerable older persons. See Appendix A for a listing of the ACOVE indicators for each of the three clinical conditions included in this study.