The American College of Surgeons (ACS), in partnership with the John A. Hartford Foundation, announced a four-year initiative aimed at improving health care for older surgical patients through a standards and verification program for hospitals. The initiative, issued June 11, features leaders who are pioneers in the field of geriatric surgery and long-time Hartford grantees, Clifford Y. Ko, MD, MS, MSHS, FACS, Director of the ACS Division of Research and Optimal Patient Care, and Ronnie Rosenthal, MD, FACS, Chair of the ACS Geriatric Surgery Task Force and chief of surgery at the Veterans Affairs Connecticut Healthcare System. The Hartford Foundation awarded a $2.9 million grant for the program.
Growing need for geriatric care
The U.S. geriatric population continues to grow. The Census Bureau reports that more people were 65 years and older in 2010 than in any previous census. Moreover, the largest percentage point increase for the “oldest-old population” (defined as age 85 and older) over the previous two decades was concentrated in the 90- to 94-year-old age group, which increased from 25 percent of the oldest-old group in 1990 to 26.2 percent in 2000, and 26.4 percent in 2010.*
“More than ever, 80, 90, and even 100-year-olds are undergoing surgery, and that trend will only grow. This important partnership between the John A. Hartford Foundation and the ACS to develop standards and then verify that hospitals can deliver optimal geriatric surgical care will save lives, improve outcomes, and reduce harm for older adults across the country,” said Terry Fulmer, PhD, RN, FAAN, president of the Hartford Foundation.
The ACS has long been committed to quality geriatric surgical care. In 2012, the ACS, in partnership with the American Geriatrics Society, published joint guidelines in the Journal of the American College of Surgeons for the perioperative care of the nation’s elderly patients.† These standards apply to every surgical patient ages 65 and older as defined by Medicare regulations.
“We have worked with the John A. Hartford Foundation for many years to develop meaningful tools for improving geriatric surgical care. The current project aims to develop and integrate geriatric surgery standards that will help facilities with infrastructure, standards, processes and protocols, and the integration of data—all to improve the care of the geriatric surgical patient,” Dr. Ko said.
Setting the standards
The Geriatric Surgery Verification and Quality Improvement Program will produce a framework for all hospitals, regardless of size, location, or population served, to improve the quality of care they provide to older adults undergoing surgery. The project will convene experts and engage a broad set of stakeholders representing patients, families, caregivers, multidisciplinary health providers, and industry payors, with the following objectives:
Set standards for hospitals related to the needed infrastructure for optimal care (for example, staffing, resources, and care processes).
Select and develop measures that matter for older patients against which hospitals can be assessed and target areas for improvement. (This objective will include new patient-reported outcomes.)
Develop educational resources for patients and providers.
Build a peer-review verification program that promotes public assurance and a culture of improvement, similar to the ACS’ successful cancer, trauma, and bariatric quality programs, which have been shown to improve care and save lives.
“This is a great opportunity to improve the care and outcomes of geriatric surgery patients—and is relevant to nearly all fields in surgery. This program will involve several disciplines and be a total team effort,” Dr. Ko said.
This work builds on the ACS’ robust data collection and quality improvement infrastructure. It will draw upon the network of experts and growing evidence base in geriatric surgery that has been developed with support from the foundation over the last 20 years.
“The ACS has a long and successful track record of helping hospitals build an infrastructure for surgical quality improvement,” said Christopher A. Langston, PhD, Hartford Foundation program director. “This new verification program will make it easier for hospitals and health systems to focus on doing their best for the large and vulnerable patient population of older adults—and receive public credit for providing them with the right kind of care.”
*U.S. Census Bureau Statistical Brief. The Older Population: 2010. Available at: www.census.gov/prod/cen2010/briefs/c2010br-09.pdf. Accessed June 9, 2015.
†Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453-466.