Developing Quality Indicators to Improve the Care in Elderly Surgery Patients

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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.