Discussion
Quality indicators (QI) are quantitative measures that may be utilised to enable levels of performance to be determined and, as part of a quality management system, provide opportunity for benchmarking and improved care delivery.[29] They may also support accreditation, regulation, and patient and healthcare purchaser choice. This study will result in a suite of QIs for use in the ED care of elderly that will be:
Valid
Derived utilizing clinical data items from multiple sources, including a site audit, patient interview, administrative databases, the interRAI ED assessment tool and the medical record
Feasible in terms of both cost & measurement
Assess the full spectrum of Donabedian's domains including structure, process and outcomes[64]
Designed utilizing data items and processes that are not unique to any one particular developed nation.
The predicted burgeoning in the number of older persons presenting to EDs combined with the recognised quality deficiencies in ED care delivery to this population, highlight the need for a quality framework for the care of older persons in ED. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients.[28] The development of well-selected, validated and economical QIs will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement. Conversely, the "blind" application of QIs not designed for nor tested in the ED setting, particularly in the absence of appropriate risk adjustment, may result in inappropriate misdirection of funding.
Abbreviations
ED: Emergency department; QI(s): Quality indicator(s).
Authors' contributions
EB and LG established the project and the project team. MMK conceptualised the research design. MMK, EB, LS, and LG jointly refined the research methodology and wrote the research protocol. MMK, EB and LS jointly drafted the first manuscript and extensively revised following feedback from other authors. LG and RJ extensively reviewed the manuscript and contributed to the revisions prior to submission. MMK coordinated the submission process. All authors read and approved the final manuscript.
BMC Emerg Med. 2013;13(23) © 2013
BioMed Central, Ltd.
