title: Developing quality indicators for elderly surgical patients.
abstract: OBJECTIVE
  To develop process-based quality indicators to improve perioperative care for elderly surgical patients.
  
  
  BACKGROUND
  The population is aging and expanding, and physicians must continue to optimize elderly surgical care to meet the anticipated increase in surgical services. We sought to develop process-based quality indicators applicable to virtually all disciplines of surgery to identify necessary and meaningful ways to improve surgical care and outcomes in the elderly.
  
  
  METHODS
  We identified candidate perioperative quality indicators for elderly patients undergoing ambulatory, or major elective or nonelective inpatient surgery through structured interviews with thought leaders and systematic reviews of the literature. An expert panel of physicians in surgery, geriatrics, anesthesia, critical care, internal, and rehabilitation medicine formally rated the indicators using a modification of the RAND/UCLA Appropriateness Methodology.
  
  
  RESULTS
  Ninety-one of 96 candidate indicators were rated as valid. They were categorized into 8 domains: comorbidity assessment, elderly issues, medication use, patient-provider discussions, intraoperative care, postoperative management, discharge planning, and ambulatory surgery. Of note, 71 (78%) of the indicators rated as valid address processes of care not routinely performed in younger surgical populations.
  
  
  CONCLUSIONS
  Attention to the quality of care in elderly patients is of great importance due to the increasing numbers of elderly undergoing surgery. This project used a validated methodology to identify and rate process measures to achieve high quality perioperative care for elderly surgical patients.
authors.affiliation: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-6904, USA. mmcgory@mednet.ucla.edu
authors.forename: Marcia L
authors.initials: ML
authors.lastname: McGory
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Kao
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
authors.forename: Laurence Z
authors.initials: LZ
authors.lastname: Rubenstein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Leonardi
authors.forename: Janak A
authors.initials: JA
authors.lastname: Parikh
authors.forename: Arlene
authors.initials: A
authors.lastname: Fink
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
mesh_terms: D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures; D013502:General Surgery / Q000592:standards*; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D019990:Perioperative Care; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000592:standards*