Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study

Abstract

Objective: To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes.

Design: An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers).

Setting: Western Europe and the USA.

Participants: Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate).

Measures: Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method.

Results: In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications.

Conclusion: The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes.

Keywords: Delphi; co-management; evaluation; geriatric medicine; implementation; quality.

Figure 1

Outcomes reported by co-management programmes. The bar chart reports the number of programmes reporting a particular outcome. DALY, disability-adjusted life year.

Figure 2

Flowchart of Delphi process. Consensus was determined based on the level of agreement using the RAND/UCLA Appropriateness Method. Indicators were rated on a scale of 1 to 9, and considered appropriate and feasible based on a medium score of 7 or higher. Of the 17 outcome indicators that were considered feasible, 16 were also considered appropriate.