Three-year project to improve the surgical care of older adults is now underway to evaluate the program as it's put into place in real settings, adapt it to more settings, and develop palliative care standards
With support from JAHF, ACS is using the three-year award to evaluate the content, implementation, and outcomes of the GSV Program as it is put into place in real settings, and to make any necessary adaptive changes to foster broad dissemination of this program around the U.S., including rural settings and safety net hospitals. A key part of this work will include developing and incorporating standards for palliative care (a current gap in the GSV Program), and then determine opportunities for alignment with other existing JAHF and ACS quality improvement programs.
"We want to make quality surgical care available to all older adults across the U.S. and this project takes a big step in that direction. Our goal for evaluating how the GSV Program is functioning in the real world is to gain insight to adjust and align program standards so the GSV framework truly fits and benefits all hospitals and their older surgical patients—regardless of a hospital's size, location, population served, or teaching status," said Clifford Y. Ko, MD, MSHS, FACS, FASCRS, project principal investigator and Director, ACS Division of Research and Optimal Patient Care.
This new project builds on the already strong relationship between ACS and JAHF following their four-year partnership (2015-2019) that led to developing effective standards for the launch of the ACS Geriatric Verification Surgery Program for hospitals in July 2019.
"The American College of Surgeons is leading the way to ensuring that surgical care is safe, effective, and age-friendly by focusing on what matters most to older adults and their families, especially in the context of living with serious illness. Through rigorous real-world testing and improvement, new palliative care standards, and a laser focus on ensuring equitable access to high-quality surgical care, the Geriatric Surgery Verification Program is solidifying its role as a 'must-have' for any health system." ~ Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation
Research team members for the current project are from ACS and Brigham and Women's Hospital Center, Boston; all have geriatric and palliative care expertise. These researchers will collaborate with a diverse group of stakeholders and a professional evaluation organization to determine the merits of the GSV Program, the success and degree of implementation of the standards, maintenance of the program in the hospital, and patient outcomes that result from participation. The team anticipates selecting eight to 10 GSV hospitals at various levels of participation for this evaluation.
"Surgeons treat patients with many conditions that can often occur with aging, such as cancer, cardiovascular disease, and musculoskeletal disorders. With the number of older adults increasing throughout the U.S., there's a compelling need to address their distinct surgical care needs. This new partnership will be a catalyst for involving more hospitals in our Geriatric Surgery Verification Program and bring specialized surgical care to more older adults closer to home," said ACS Executive Director Patricia L. Turner, MD, MBA, FACS.
The project's key stakeholders will come from a diverse group of patients and professionals interested in the health outcomes of older adults and include representation from other JAHF programs and ACS quality programs. A professional evaluation organization will be selected that has expertise in health care program needs assessment, process evaluation, data analysis, and reporting and dissemination, accompanied by a track record for understanding issues of diversity, equity, and inclusion.
It's anticipated that stakeholders and palliative care experts will develop three to five palliative care standards to be piloted in several GSV program sites. Current GSV standards only include a screen for palliative care so developing further palliative care standards will complete this important area of focus for vulnerable older adults with more serious illness.
"Our data estimates that over 1,000,000 seriously ill older adults undergo major surgery every year. Furthermore, we know that seriously ill patients benefit from palliative care in terms of decision making that is concordant with their goals, symptom management, and quality of life. Therefore, it is imperative that we integrate palliative care into surgical care for these patients to meet and support the complex needs of these patients and their families," said Zara Cooper, MD, MSc, FACS, project co-investigator and acute care surgeon, trauma surgeon, and surgical intensivist at Brigham and Women's Hospital (BWH) where she serves as Kessler Director for the Center for Surgery and Public Health (CSPH).
"This project is really a landmark initiative on the part of the American College of Surgeons and The John A. Hartford Foundation. Historically palliative care has been reserved only for patients at the very end of life. This initiative is paradigm changing for surgery by recognizing that palliative care should be provided at any stage of serious illness even when patients undergo major surgery for curative intent," she concluded.
"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.
