Blog | Quality Improvement

Analysis: Improving surgical care by engaging older adults in shared decision-making

Blog | Quality Improvement

Analysis: Improving surgical care by engaging older adults in shared decision-making

  • Kaiser Health News is reporting the American College of Surgeons has endorsed new standards of surgical care for older adults.
  • Engaging patients of all ages in shared decision-making discussions has been shown to improve outcomes.
  • The ACS’s Geriatric Surgery Verification Program is a step in the right direction given that conversations about shared decision-making or advanced directives don’t happen as frequently as they should.

Kaiser Health News is reporting in an Aug. 1 article “The Talk Seniors Need To Have With Doctors Before Surgery” that the American College of Surgeons has endorsed new standards. The standards include:

  • Providing older adults with the opportunity to discuss their health goals and expectations for recovery preoperatively with their surgeon.
  • Surgeons reviewing a patient’s advance directive or offering to help the patient complete one.
  • Surgeons clearly identifying if a stay in an ICU is likely post-operatively. If it is, there needs to be a discussion related to the patient’s wishes on issues ranging from feeding tubes to mechanical ventilation to cardiac resuscitation.

Takeaway

Despite the well-documented improvements in patient experience of care, outcomes and reduction in the total cost of care, engaging the patient in shared decision-making or advanced directives discussions doesn’t happen as frequently as it should. So, the ACS’s Geriatric Surgery Verification Program is a step in the right direction. 

Decision aid improves patient experience of care: A 2012 study published in Health Affairs reports that patients who use decision aids:

  • Report feeling more engaged in their care process.
  • Experience reduced uncertainty about the decision.
  • Have more realistic expectations for outcomes.

The Health Affairs study found that beyond improvements in patient experience of care, 25% of patients who use the decision-aid tools elect not to have surgery.

Making end-of-life choices known in advance improves outcomes: Having a documented advanced directive has been shown to improve the quality of care for both decedents and their survivors across a range of factors. Those factors include:

  • The quality of death, as reported by next-of-kin, is higher for decedents who die at home or in hospice care, as outlined in an abstract in PubMed.gov of a July 24, 2002 Journal of Pain and Symptom Management article.
  • It also reduces the detrimental impact to physical and mental health that caregivers experience following deaths characterized by use of aggressive end-of-life care.
  • It reduces the likelihood that surviving spouses will die shortly thereafter, according to a 2008 JAMA Network article.

Should CMS consider a similar quality measure? Although I’m not sure the Centers for Medicare and Medicaid Services needs to pile another quality measure into Merit-based Incentive Payments or the Bundled Payments for Care Improvement Advanced programs, something around adherence to the ACS guidelines might make sense.

About the Authors

Chad Mulvany, FHFMA

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office, and a member of HFMA’s Virginia-Washington, D.C., Chapter.

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