Use of consensus methods to select clinical indicators to assess activities to minimise functional decline among older hospitalised patients

Abstract

The study aimed to develop a set of clinical indicators to minimise the risk and adverse outcomes of functional decline in older hospitalised people. Existing Australian and international clinical indicators relevant to cognition and emotional health, mobility, vigour and self care, continence, nutrition, skin integrity, person-centred care, assessment and medication management were identified by literature and electronic website review. A multidisciplinary expert advisory group used modified Delphi methods, including two anonymous voting rounds and a group discussion, to gain consensus for a prioritised set of clinical indicators. For each indicator, experts voted on a scale of 1 (low level of prioritisation) to 9 (high level of prioritisation) based on measurement attributes and utility for use at the level of clinical teams, hospital managers and jurisdictional policy makers. There were 55 existing clinical indicator sets identified, from which 63 relevant indicators were extracted. The final prioritised set covered all domains and included 19 indicators of which 17 were process indicators and 2 were outcome indicators. Scores for scientific measurement attributes and practicality for implementation were only moderate. These clinical indicators offer a consistent basis for monitoring hospital performance and improving care of older people in Victoria and other jurisdictions.