Application of the RAND-UCLA Appropriateness Methodology to a Large Multidisciplinary Stakeholder Group Evaluating the Validity and Feasibility of Patient-Centered Standards in Geriatric Surgery

Julia R. Berian, Tracey L. Baker, Ronnie A. Rosenthal, Jo Ann Coleman, Emily Finlayson, Mark R. Katlic, Sandhya A. Lagoo-Deenadayalan, Victoria L. Tang, Thomas N. Robinson, Clifford Y. Ko, Marcia M. Russell

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objectives: To explore (1) differences in validity and feasibility ratings for geriatric surgical standards across a diverse stakeholder group (surgeons vs. nonsurgeons, health care providers vs. nonproviders, including patient-family, advocacy, and regulatory agencies); (2) whether three multidisciplinary discussion subgroups would reach similar conclusions. Data Source/Study Setting: Primary data (ratings) were reported from 58 stakeholder organizations. Study Design: An adaptation of the RAND-UCLA Appropriateness Methodology (RAM) process was conducted in May 2016. Data Collection/Extraction Methods: Stakeholders self-administered ratings on paper, returned via mail (Round 1) and in-person (Round 2). Principal Findings: In Round 1, surgeons rated standards more critically (91.2 percent valid; 64.9 percent feasible) than nonsurgeons (100 percent valid; 87.0 percent feasible) but increased ratings in Round 2 (98.7 percent valid; 90.6 percent feasible), aligning with nonsurgeons (99.7 percent valid; 96.1 percent feasible). Three parallel subgroups rated validity at 96.8 percent (group 1), 100 percent (group 2), and 97.4 percent (group 3). Feasibility ratings were 76.9 percent (group 1), 96.1 percent (group 2), and 92.2 percent (group 3). Conclusions: There are differences in validity and feasibility ratings by health professions, with surgeons rating standards more critically than nonsurgeons. However, three separate discussion subgroups rated a high proportion (96–100 percent) of standards as valid, indicating the RAM can be successfully applied to a large stakeholder group.

Original languageEnglish (US)
Pages (from-to)3350-3372
Number of pages23
JournalHealth services research
Volume53
Issue number5
DOIs
StatePublished - Oct 2018

Bibliographical note

Funding Information:
Joint Acknowledgment/Disclosure Statement: Funding for the CQGS project was provided by a grant from the John A. Hartford Foundation. The funder did not influence the interpretation of findings or decision to publish. The CQGS leadership committee would like to thank the CQGS stakeholder organizations and their designated representatives, which are detailed below, for their contributions to this project. American Association of Retired Persons, Susan Reinhard, RN, PhD, FAAN ACS Advisory Council for Rural Surgery, Phillip Caropreso, MD, FACS ACS Committee on Surgical Palliative Care, Anne Mosenthal, MD, FACS Aetna, Joseph Agostini, MD The Society for Post Acute and Long Term Care Medicine (?AMDA?), Naushira Pandya, MD, CMD, FACP American Academy of Ophthalmology, Hilary Beaver, MD American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons, Timothy Brox, MD American Academy of Otolaryngology, Kourosh Parham, MD, PhD, FACS American Academy of Physical Medicine and Rehabilitation, Richard Zorowitz, MD American College of Emergency Physicians, Ula Hwang, MD American College of Physicians, Cynthia Smith, MD, FACP American Geriatrics Society, Nancy Lundebjerg, MPA American Hospital Association, Health Research & Educational Trust, Ken Anderson, DO, MS, CPE American Society of Anesthesiologists, Stacie Deiner, MD, and Mark Neuman, MD, PhD American Society of Consultant Pharmacists, Sharon Clackum, PharmD, CGP, CDM, FASCP American Society of Health-System Pharmacists, Deborah Pasko, PharmD and Kasey Thompson, PharmD, MS, MBA American Society of PeriAnesthesia Nurses, Vallire Hooper, PhD, RN, CPAN, FAAN American Urological Association, Peter Albertsen, MD Association of periOperative Registered Nurses, Susan Bakewell, MS, RN-BC Association of Veterans Affairs Surgeons, Jason Johanning, MD, MS, FACS Case Management Society of America, Cheri Lattimer Center to Advance Palliative Care, Diane Meier MD, FACP, and Brynn Bowman Centers for Medicare and Medicaid Services, Shari Ling, MD Eastern Association for the Surgery of Trauma, James Forrest Calland, MD, FACS Family Caregiver Alliance, Kathleen Kelly, MPA Florida Hospital Association, Martha DeCastro, MS, RN Geriatrics for Specialists Initiative, William Lyons, MD Gerontological Advanced Practice Nurses Association, Julie Stanik-Hutt, PhD, CRNP Hartford Institute for Geriatric Nursing and Nurses Improving Care for Healthsystem Elders, Tara Cortes, PhD, RN Hospital Elder Life Program, Sharon Inouye, MD, MPH Kaiser Permanente, Laurel Imhoff, MD, FACS Memorial Sloan Kettering Cancer Center, Larissa Temple, MD, FACS National Association of Social Workers, Chris Herman, MSW, LICSW National Committee for Quality Assurance, Judy Ng and Erin Giovannetti, PhD National Gerontological Nursing Association, Elizabeth Tanner, Phd, RN, and Joanne Alderman, MS-N, APRN-CNS, RN-BC, FNGNA Nurses Improving Care for Healthsystem Elders, Barbara Bricoli, MPA, and Holly Brown, MSN Patient and Family Centered Care Partners, Libby Hoy Patient Priority Care, Mary Tinetti, MD Pharmacy Quality Alliance, Woody Eisenberg, MD University of Pennsylvania Center for Perioperative Outcomes Research and Transformation, Sushila Murthy, MD Society for Academic Emergency Medicine, Teresita Hogan, MD Society of Critical Care Medicine, Jose Diaz, MD, FCCM Society of Hospital Medicine, Melissa Mattison, MD, FACP, SFHM Society of General Internal Medicine, Lee Lindquist, MD, MPH, MBA The American Association for the Surgery of Trauma, Robert Barraco, MD, FACS, and Zara Cooper, MD, FACS The American Board of Surgery, Mark Malangoni, MD, FACS The American Congress of Obstetricians and Gynecologists, Holly Richter, MD The Beryl Institute, Jason Wolf, PhD The Gerontological Society of America The John A. Hartford Foundation, Marcus Escobedo, MPA The Society of Thoracic Surgeons, Joseph Cleveland, MD University of Alabama ? The Division of Gerontology, Geriatrics and Palliative Care, Kellie Flood, MD University of Chicago ? the MacLean Center for Clinical Medical Ethics, Peter Angelos, MD, FACS University of Colorado, Division of Health Care Policy and Research, Eric Coleman, MD, MPH University of Pittsburgh Medical Center, Daniel Hall, MD University of Wisconsin School of Medicine & Public Health, Gretchen Schwarze, MD, MPP, FACS US Department of Veterans Affairs, Geriatrics and Extended Care, Thomas Edes, MD, MS Yale New Haven Patient Experience Council, Michael Bennick, MD Disclosures: Emily Finlayson is founding shareholder Ooney, Inc. No additional disclosures for the remaining authors. Disclaimer: None.

Funding Information:
Joint Acknowledgment/Disclosure Statement: Funding for the CQGS project was provided by a grant from the John A. Hartford Foundation. The funder did not influence the interpretation of findings or decision to publish. The CQGS leadership committee would like to thank the CQGS stakeholder organizations and their designated representatives, which are detailed below, for their contributions to this project. 1 American Association of Retired Persons, Susan Reinhard, RN, PhD, FAAN 2 ACS Advisory Council for Rural Surgery, Phillip Caropreso, MD, FACS 3 ACS Committee on Surgical Palliative Care, Anne Mosenthal, MD, FACS 4 Aetna, Joseph Agostini, MD 5 The Society for Post Acute and Long Term Care Medicine (“AMDA”), Naushira Pandya, MD, CMD, FACP 6 American Academy of Ophthalmology, Hilary Beaver, MD 7 American Academy of Orthopaedic Surgeons/American Associa-tion of Orthopaedic Surgeons, Timothy Brox, MD 8 American Academy of Otolaryngology, Kourosh Parham, MD, PhD, FACS 9 American Academy of Physical Medicine and Rehabilitation, Richard Zorowitz, MD 10 American College of Emergency Physicians, Ula Hwang, MD 11 American College of Physicians, Cynthia Smith, MD, FACP 12 American Geriatrics Society, Nancy Lundebjerg, MPA 13 American Hospital Association, Health Research & Educational Trust, Ken Anderson, DO, MS, CPE 14 American Society of Anesthesiologists, Stacie Deiner, MD, and Mark Neuman, MD, PhD 15 American Society of Consultant Pharmacists, Sharon Clackum, PharmD, CGP, CDM, FASCP 16 American Society of Health-System Pharmacists, Deborah Pasko, PharmD and Kasey Thompson, PharmD, MS, MBA 17 American Society of PeriAnesthesia Nurses, Vallire Hooper, PhD, RN, CPAN, FAAN 18 American Urological Association, Peter Albertsen, MD

Publisher Copyright:
© Health Research and Educational Trust

Keywords

  • Delphi methods
  • RAND-UCLA Appropriateness Method
  • geriatric surgery

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