of a data registry that can track important data elements and outcomes as defined by the standards. The
project aims to develop measures that matter to older
adults, which may include longer-term outcomes like
a return to previous level of functioning. Drawing on
the experience of the ACS NSQIP Geriatric Surgery
Pilot Project, we will begin to refine patient-centered
outcomes in important domains, including cognition,
function, mobility, and decision making.
As the payment system shifts in the coming
years, many payors, including CMS, will attempt
to better align compensation with quality of care.
The CQGS Project will provide a streamlined set
of standards for processes of care, and a system for
data collection and measurement of outcomes that
are not only important to providers but also to the
patients whom we serve. Furthermore, external
peer verification will provide public assurance of
the quality of care for older surgical patients. With
the newly proposed QPP, the current project has the
potential to contribute meaningful quality metrics
for surgeons who care for older adults.
The expanding and aging U.S. population has created a growing demand for high-quality care in
geriatric surgery. As the population continues to
age, the number of elderly patients requiring surgical intervention will continue to increase. Surgeons,
geriatricians, internists, and other health care providers need to become more familiar with the complex
interdisciplinary issues unique to the growing elderly
patient population. It is the vision of the ACS, in partnership with the John A. Hartford Foundation, that
the CQGS project will lead the effort to improve care
for every older surgical patient. ♦
11. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner
LA, Moss M. Postoperative delirium in the elderly: Risk
factors and outcomes. Ann Surg. 2009;249( 1):173-178.
12. Berian JR, Rosenthal RA. Redefining quality of surgical care
for the frail elderly. Curr Surg Rep. 2016; 4( 3): 1-11.
13. Fried TR, Bradley EH, Towle VR, Allore H. Understanding
the treatment preferences of seriously ill patients. N Engl J
Med. 2002;346( 14):1061-1066.
14. The Coalition for Quality in Geriatric Surgery Project.
American College of Surgeons: Quality Programs. Available
at: facs.org/quality-programs/geriatric-coalition. Accessed
October 26, 2016.
15. Chow WB, Rosenthal RA, Merkow RP, et al. 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.
16. Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko
CY, Esnaola NF. Optimal perioperative management of
the geriatric patient: A best practices guideline from the
American College of Surgeons NSQIP and the American
Geriatrics Society. J Am Coll Surg. 2016;222( 5):930-947.
17. McGory ML, Kao KK, Shekelle PG, et al. Developing
quality indicators for elderly surgical patients. Ann Surg.
18. American Geriatrics Society expert panel on postoperative
delirium in older adults. American geriatrics society
abstracted clinical practice guideline for postoperative
delirium in older adults. J Am Geriatr Soc. 2015; 63( 1):142-150.
19. U.S. Institute of Medicine. Committee on Standards for
Developing Trustworthy Clinical Practice Guidelines.
Graham R. Clinical Practice Guidelines We Can Trust.
Washington, DC: National Academies Press; 2011.
20. Robinson TN, Rosenthal RA. The ACS NSQIP Geriatric
Surgery Pilot Project: Improving care for older surgical
patients. Bull Am Coll Surg. 2014; 99( 10): 21-23.
21. Borson S, Scanlan JM, Chen P, Ganguli M. The mini-cog as a
screen for dementia: Validation in a population-based sample.
J Am Geriatr Soc. 2003; 51( 10):1451-1454.
22. Cassel CK. Quality of care and quality of training: A shared
vision for internal medicine? Ann Intern Med. 2004;140( 11):927-
23. Podsiadlo D, Richardson S. The timed “Up & Go”: A test of
basic functional mobility for frail elderly persons. J Am Geriatr
Soc. 1991; 39( 2):142-148.
The project will soon begin development of a data registry that
can track important data elements and outcomes as defined
by the standards. The project aims to develop measures
that matter to older adults, which may include longer-term
outcomes like a return to previous level of functioning.