Developing Quality Indicators to Improve the Care in Elderly Surgery Patients

描述（申请人提供）：人口老龄化，预计将有越来越多的老年患者接受手术。在这方面，本应用程序的首要目标是提高对接受手术的老年患者的护理质量。更具体地说，该项目将制定质量指标，可用于评估和提高接受住院外科手术（即任何计划术后住院的外科手术）的老年患者的护理质量。该应用程序建立在先前的试点工作基础上，该试点工作由美国老年医学会（ACS）的Dennis W. Jahnigen职业发展学者奖资助。在那个项目中，我们能够为接受腹部手术的老年患者制定质量指标。基于这些发现，我们现在假设可以确定一套适用于几乎所有住院外科学科（如心胸外科、结直肠外科、普通外科、妇科、骨科、泌尿外科和血管外科）的老年人特异性指标。使用RAND/UCLA适当性方法论，这是一种识别质量指标的有效技术，我们将首先开发一个有效质量指标的列表。然后，我们将根据优先级/重要性进一步对指标进行评级，以确定一组可实施的指标（例如n=10-15）。我们将开发一个标准化的病历提取表格，以便可靠、准确地从病历中收集数据。最后，我们将在两种不同临床设置的方便样本中对老年人手术护理的质量进行评估。虽然在我们的医疗环境中越来越多地使用质量指标来衡量和提高医疗条件（如急性心肌梗死、心力衰竭、肺炎）的护理质量，但针对手术的工作却很少。在这方面制定质量指标可能有助于提高这一弱势群体的护理质量。我们期望这一单一的质量指标将适用于所有外科学科，并成为一种新颖、简单、有用的机制，用于评估、基准设定和提高老年外科患者的护理质量。重要的是，这些目标与国家老龄研究所老年科对健康问题、多发性疾病和残疾的关注是一致的。

DESCRIPTION (provided by applicant): The population is aging and increasing numbers of elderly patients are predicted to undergo surgery. In this regard, this application's overarching aim is to improve the quality of care delivered to elderly patients who undergo surgery. More specifically, this project will develop quality indicators that may be used to evaluate and improve the quality of care for elderly patients undergoing inpatient surgical procedures (i.e. any surgical procedure that has a planned postoperative stay). This application builds on prior pilot work funded through a Dennis W. Jahnigen Career Development Scholars Award from the American Geriatrics Society (ACS). In that project, we were able to develop quality indicators for elderly patients specifically undergoing abdominal surgery. Based on those findings, we now hypothesize that a single set of elderly-specific indicators may be identified that are universally applicable to virtually all disciplines of inpatient surgery (e.g. cardiothoracic, colorectal, general, gynecology, orthopedic, urology, and vascular surgery). Using the RAND/UCLA Appropriateness Methodology, which is a validated technique for identifying quality indicators, we will first develop a list of valid quality indicators. We will then further rate the indicators based on priority/importance in order to identify an implementable set (e.g. n=10-15) of indicators. We will develop a standardized medical record abstraction form so data can be reliably and accurately collected from the medical record. Finally, we will perform an evaluation of the quality of elderly surgical care in a convenience sample of two different clinical settings. While quality indicators are becoming increasingly utilized in our healthcare environment to measure and improve the quality of care for medical conditions (e.g. acute myocardial infarction, heart failure, pneumonia), extremely little work has been performed targeting surgery. Developing quality indicators in this regard will likely prove useful for improving the quality of care in this vulnerable population. We expect that this single set of quality indicators will be universal to all surgical disciplines, and be a novel, easy, and useful mechanism for evaluating, benchmarking, and improving the quality of care for elderly surgical patients. Importantly, these aims align well with the National Institute of Aging Geriatric Branch's focus on health issues, multiple morbidity, and disability.