Melissa A Hornor1,2, Victoria L Tang3, Julia Berian1,4, Thomas N Robinson5, JoAnn Coleman6, Mark R Katlic6, Ronnie A Rosenthal7, Kataryna Christensen1, Tracey Baker1, Emily Finlayson8, Sandhya A Lagoo-Deenadaayalan9, Clifford Y Ko1,10, Marcia M Russell10. 1. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California. 4. Department of Surgery, University of Chicago, Chicago, Illinois. 5. Department of Surgery, University of Colorado, Denver, Aurora, Colorado. 6. Department of Surgery, Sinai Center for Geriatric Surgery, Sinai Hospital, Baltimore, Maryland. 7. Department of Surgery, Yale University, New Haven, Connecticut. 8. Department of Surgery, University of California, San Francisco, San Francisco, California. 9. Department of Surgery, Duke University, Durham, North Carolina. 10. Department of Surgery, University of California, Los Angeles, Los Angeles, California.
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.
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.
Authors: Kahli E Zietlow; Serena Wong; Mitchell T Heflin; Shelley R McDonald; Robert Sickeler; Michael Devinney; Jeanna Blitz; Sandhya Lagoo-Deenadayalan; Miles Berger Journal: Am J Med Date: 2021-08-18 Impact factor: 4.965