Developing Quality Indicators for Elderly Patients Undergoing Abdominal Operations - 21/08/11
⁎, Paul G. Shekelle, MD, PhD ‡, Laurence Z. Rubenstein, MD, MPH ‡, Arlene Fink, PhD †, Clifford Y. Ko, MD, MS, MSHS , § : FACS Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA Correspondence address: Marcia L McGory, MD, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, 72-215 Center for Health Sciences, Box 956904, 10833 Le Conte Ave, Los Angeles, CA 90095-6904.Résumé |
Background |
Although the expanding and aging population will likely increase demand for surgical services, surgeons and other providers must develop strategies to optimize care. We sought to develop process-based quality indicators for elderly patients undergoing abdominal operations to identify necessary and meaningful ways to improve care in this cohort.
Study design |
Through structured interviews with thought leaders and systematic reviews of the literature, we identified candidate quality indicators addressing perioperative care in elderly patients undergoing abdominal operations. Using a modification of the RAND/UCLA Appropriateness Methodology, an expert panel of physicians in surgery, geriatrics, anesthesia, internal, and rehabilitation medicine formally rated and discussed the indicators.
Results |
Eighty-nine candidate indicators were identified and categorized into seven domains: comorbidity assessment (eg, cardiopulmonary disease), elderly issues (eg, cognition), medication use (eg, polypharmacy), patient-to-provider discussions (eg, life-sustaining preferences), intraoperative care (eg, preventing hypothermia), postoperative management (eg, preventing delirium), and discharge planning (eg, home health care). Of the 89 candidate indicators, 76 were rated as valid by the expert panel. Importantly, the majority of indicators rated as valid address processes of care not routinely performed in younger surgical populations.
Conclusions |
Attention to the quality of surgical care in elderly patients is of great importance because of the increasing numbers of elderly undergoing operations. This project used a validated methodology to identify and rate process measures to achieve high-quality perioperative care for elderly surgical patients. This is the first time quality indicators have been developed in this regard.
Le texte complet de cet article est disponible en PDF.Plan
| Competing Interests Declared: None. Supported by grants from UniHealth Foundation, Hartford Foundation and American Geriatrics Society, and Robert Wood Johnson Clinical Scholars Program at UCLA. |
Vol 201 - N° 6
P. 870-883 - décembre 2005 Retour au numéro
Article précédent
- Clinical and Pathologic Features of Proximal Biliary Strictures Masquerading as Hilar Cholangiocarcinoma
- Carlos U. Corvera, Leslie H. Blumgart, Farbod Darvishian, David S. Klimstra, Ronald DeMatteo, Yuman Fong, Michael D’Angelica, William R. Jarnagin
- Developing an Appropriate Staging System for Esophageal Carcinoma
- Chikara Kunisaki, Hirotoshi Akiyama, Masato Nomura, Goro Matsuda, Yuichi Otsuka, Hidetaka Andrew Ono, Hiroshi Shimada
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?