Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative

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

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

BACKGROUND: The American College of Surgeons Coalition for Quality in Geriatric Surgery is a multidisciplinary stakeholder group that aims to systematically improve the surgical care of older adults by establishing a verifiable quality improvement program with standards based on best evidence. Prior work confirmed the validity of a preliminary set of 308 standards to improve the quality of geriatric surgery, but concerns exist as to whether the standards are feasible for hospitals to implement. OBJECTIVE: Our aim was to utilize data gained from a multi-institutional survey and interview to improve the scalability and generalizability of a geriatric quality improvement program. METHODS: Using a survey followed by a targeted debrief interview, 15 hospitals gathered an interdisciplinary panel to answer whether each standard was already in place at their institution, and if not, the perceived difficulty of implementation according to a five-point Likert scale (from 1 [very easy] to 5 [very difficult]). The standards were then placed into categories according to the hospital responses. Standards were designated “duplicative” if 11 or more hospitals reported baseline implementation, “prohibitively difficult” if 6 or more hospitals rated the standard as such, and “high potential” if they were neither duplicative nor difficult. A targeted debrief interview was then conducted with each participating hospital. RESULTS: Fifteen participating hospitals evaluated the feasibility of 108 standards and found 28 (26%) duplicative, 35 (32%) too difficult, and 45 (42%) high potential. Of the 108 standards, 49 (45%) were selected for the next iteration of standards, and 59 were removed. Among the standards that were removed, the majority (64%) were rated duplicative and/or difficult. CONCLUSION: A multi-institutional survey and interview successfully identified care standards that were redundant or too difficult to implement on the hospital level. These data will help improve the generalizability and scalability of the program while maintaining the overall goal of improving care. J Am Geriatr Soc 67:1074–1078, 2019.

Original languageEnglish (US)
Pages (from-to)1074-1078
Number of pages5
JournalJournal of the American Geriatrics Society
Volume67
Issue number5
DOIs
StatePublished - May 2019

Bibliographical note

Funding Information:
We would like to thank the hospitals that participated in the study. Durham Veterans Affairs Medical Center, Durham, NC Veterans Affairs Connecticut Healthcare System, Newington, CT Brigham and Women's Hospital, Boston, MA Moses H. Cone Memorial Hospital, Greensboro, NC Duke University Medical Center, Durham, NC Carroll Hospital, Westminster, MD Yale?New Haven Hospital, New Haven, CT Johns Hopkins Bayview Medical Center, Baltimore, MD Veterans Affairs Eastern Colorado Health System, Denver, CO Sinai Hospital, Baltimore, MD University of Alabama Birmingham University Hospital, Birmingham, AL Lehigh Valley, Allentown, PA Penticton Regional Hospital, Penticton, British Columbia, Canada Financial Disclosure: This project is funded by a grant from the John A. Harford Foundation, under the title ?American College of Surgeons Geriatric Surgery Verification and Quality Improvement Program.? Conflict of Interest: The authors have no conflicts of interest to report. Author Contributions: Study concept and design: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Acquisition of subjects and/or data: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Analysis and interpretation of data: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Preparation of manuscript: M.H., C.K., M.R., R.R. Sponsor's Role: The sponsor did not play a role in the design, methods, subject recruitment, data collections, analysis, and preparation of manuscript.

Funding Information:
Financial Disclosure: This project is funded by a grant from the John A. Harford Foundation, under the title “American College of Surgeons Geriatric Surgery Verification and Quality Improvement Program.” Conflict of Interest: The authors have no conflicts of interest to report. Author Contributions: Study concept and design: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Acquisition of subjects and/or data: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Analysis and interpretation of data: M.H., C.K., M.R., R.R., S.L., M.K., V.T., K.C., E.F., T.B., T.R. Preparation of manuscript: M.H., C.K., M.R., R.R. Sponsor’s Role: The sponsor did not play a role in the design, methods, subject recruitment, data collections, analysis, and preparation of manuscript.

Publisher Copyright:
© 2019 The American Geriatrics Society

Keywords

  • geriatric surgery
  • quality improvement
  • quality program development
  • surgery

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