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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Quality Improvement
Geriatrics
Interviews
Standard of Care

Keywords

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

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative. / Hornor, Melissa A.; Tang, Victoria L.; Berian, Julia; Robinson, Thomas N.; Coleman, Jo Ann; Katlic, Mark; Rosenthal, Ronnie A.; Christensen, Kataryna; Baker, Tracey; Finlayson, Emily; Lagoo-Deenadaayalan, Sandhya A.; Ko, Clifford Y.; Russell, Marcia M.

In: Journal of the American Geriatrics Society, 01.01.2019.

Research output: Contribution to journalArticle

Hornor, MA, Tang, VL, Berian, J, Robinson, TN, Coleman, JA, Katlic, M, Rosenthal, RA, Christensen, K, Baker, T, Finlayson, E, Lagoo-Deenadaayalan, SA, Ko, CY & Russell, MM 2019, 'Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative', Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15815
Hornor, Melissa A. ; Tang, Victoria L. ; Berian, Julia ; Robinson, Thomas N. ; Coleman, Jo Ann ; Katlic, Mark ; Rosenthal, Ronnie A. ; Christensen, Kataryna ; Baker, Tracey ; Finlayson, Emily ; Lagoo-Deenadaayalan, Sandhya A. ; Ko, Clifford Y. ; Russell, Marcia M. / Optimizing the Feasibility and Scalability of a Geriatric Surgery Quality Improvement Initiative. In: Journal of the American Geriatrics Society. 2019.
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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.",
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AU - Robinson, Thomas N.

AU - Coleman, Jo Ann

AU - Katlic, Mark

AU - Rosenthal, Ronnie A.

AU - Christensen, Kataryna

AU - Baker, Tracey

AU - Finlayson, Emily

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