registry, which will provide more detailed and granular information to improve surgical decision making
and align the care provided with patient goals.
Bringing together all of this groundwork, the
CQGS Project seeks to improve the quality of surgical care for older adults, regardless of the hospital’s
size, location, or teaching status. 14 The CQGS has
engaged more than 50 stakeholder organizations,
including groups representing the various surgical
disciplines, anesthesia, geriatrics, nursing, social
work, pharmacy, patient advocacy, emergency
medicine, physical therapy, community resources,
advocacy and regulatory organizations, and, perhaps most importantly, patients and families.
Two formal stakeholder meetings occurred in
the first year of the project. The goal of the first
meeting was to map out the gaps in surgical care
against the ideal future state of surgical care for
older adults. These goals are represented in Table
1, page 26, and have been used to develop recommendations to immediately improve care. In
addition, based on the input from the first stakeholder meeting, extensive literature searches,
in-person field visits to hospitals across the nation,
and targeted input from key stakeholders, 308 preliminary standards were drafted.
At the second stakeholder meeting, these preliminary standards were discussed and rated by
the stakeholders for both validity and feasibility
using a modification of the RAND/University of
California, Los Angeles, Appropriateness Method.
The analysis of stakeholder ratings is under way
to produce the final set of standards defining the
optimal care of the older adult surgical patient
across the preoperative, intraoperative, postoperative, and transition to home phases of care.
The near future
As the CQGS Project continues to evolve, the standards
will be finalized and attention will turn toward measurement. The project will soon begin development
1. Centers for Medicare & Medicaid Services Quality Payment
Program: Delivery system reform, Medicare payment reform
and MACRA. Available at: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-QPP.html. Accessed September 16, 2016.
2. U.S. Census Bureau. 2014 national population projections
summary tables. Table 6: Percent distribution of the
projected population by sex and selected age groups for the
U.S.: 2015 to 2060. Available at: www.census.gov/population/
Accessed October 26, 2016.
3. Centers for Disease Control and Prevention. Number of
discharges from short-stay hospitals, by first-listed diagnosis
and age: United States, 2010. Available at: www.cdc.gov/
Accessed October 26, 2016.
4. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging
population and its impact on the surgery workforce. Ann
Surg. 2003;238( 2):170-177.
5. Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY.
Elderly patients in surgical workloads: A population-based
analysis. Am Surg. 2003; 69( 11):961-965.
6. Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY.
Identification of specific quality improvement opportunities
for the elderly undergoing gastrointestinal surgery. Arch Surg.
7. Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld
CS, Dudley RA. Functional status after colon cancer
surgery in elderly nursing home residents. J Am Geriatr Soc.
2012; 60( 5):967-973.
8. Lawrence VA, Hazuda HP, Cornell JE, et al. Functional
independence after major abdominal surgery in the elderly. J
Am Coll Surg. 2004;199( 5):762-772.
9. Berian JR, Mohanty S, Ko CY, Rosenthal RA, Robinson
TN. Association of loss of independence with readmission
and death after discharge in older patients after surgical
procedures. JAMA Surg. September 2016. [Epub ahead of
10. Mohanty S, Liu Y, Paruch JL, et al. Risk of discharge
to postacute care: A patient-centered outcome for the
American College Of Surgeons National Surgical Quality
Improvement Program Surgical Risk Calculator. JAMA Surg.
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