Identifying a Set of Quality Indicators for Older Adults Hospitalized After Injury: An Expert Consensus Study

Older people account for over 50% of trauma admissions and are at increased risk of adverse outcomes. Several authors have proposed quality indicators for geriatric trauma care. However, there is still no consensus on those that should be used to assess the quality of care in this population. This study aims to reach a consensus on a set of indicators for assessing the quality of care of older patients hospitalized for injury.

We conducted a consensus study using the RAND-UCLA Appropriateness method, using an individual online questionnaire (round 1) and a virtual group meeting (round 2). Forty indicators identified in the literature were submitted to a panel of experts in trauma and geriatrics and three patient partners from the inclusive trauma system of the province of Quebec (Canada). Indicators were evaluated using four criteria: importance, evidence, actionability, and measurability. Consensus was defined using RAND-UCLA criteria.

30/41 (73%) invited participants completed the two rounds. In the first round, 12 indicators were retained and 14 were rejected. In the second round, three additional indicators were retained. The final set consisted of 15 indicators, including early mobilization and rehabilitation, delirium screening, documentation of the level of care < 48 h, favorable discharge destination, optimal pain management using appropriate modalities for older people, and surgical delay.

We propose a set of 15 quality indicators based on evidence, expert consensus, and patient partners' priorities that could be implemented in trauma systems and contribute to improving the quality of hospital care for older patients.