Quality Indicators for Older Persons' Transitions in Care: A Systematic Review and Delphi Process.

Area of Science:

• Geriatric Care
• Healthcare Quality Improvement
• Health Services Research

Background:

• Transitions in care for older adults (≥ 65 years) are complex and prone to quality gaps.
• Existing quality indicators (QIs) for these transitions lack standardization and consistent data capture.
• Effective monitoring requires feasible and scientifically sound QIs applicable to administrative databases.

Purpose of the Study:

• To identify and validate quality indicators (QIs) for care transitions involving older adults.
• To assess the feasibility of capturing these QIs using Canadian administrative databases.
• To address the need for standardized QI development in geriatric care transitions.

Main Methods:

• Systematic literature review to identify QIs for older adult care transitions across continuing and acute care settings.
• Two Delphi survey rounds with experts to rank QIs based on relevance, feasibility, and scientific soundness.
• Steering committee review for feasible capture in Canadian administrative databases.

Main Results:

• Identified 326 QIs from 53 sources; finalized 38 feasible indicators for current practice.
• Highest proportions of indicators targeted the emergency department (47%) and the Institute of Medicine's effectiveness domain (39.5%).
• Most feasible indicators were outcome-focused.

Conclusions:

• A set of 38 feasible quality indicators for older adult care transitions has been identified and validated.
• Significant gaps exist in standardized QI development and the capacity of current documentation systems to capture relevant data.
• Future efforts should focus on standardizing QI development and improving data capture for enhanced care transition quality.