Developing and implementing a geriatric surgery co-management program for older adults: insights from document analysis

The <i>Aging, Life Innovations, Goals and Needs-Collaboration Achieving Readiness and Empowerment</i> (ALIGN-CARE) ambulatory geriatric surgery co-management is an interdisciplinary program to better prepare frail older patients for surgery. We examined the development and implementation of this complex clinical program using the Medical Research Council (MRC) evaluative framework, document review, and analysis of program meetings. We analyzed 84 meetings (81.5 hours) generated at four recurring meeting types (advisory, interdisciplinary, surgeon, and research) between January 2020 and January 2022. Documents were coded and thematically analyzed to develop the implementation timeline, evolving program components, and implementation processes supporting program development. ALIGN-CARE evolved and stabilized four distinct components (referral, scheduling, assessment, and plan), drawing upon several implementation strategies. Each meeting drove the process in unique ways. Program flexibility and responsiveness were key ingredients driving implementation. ALIGN-CARE has matured through the adaptation of program components, with stakeholder meetings supporting these objectives. The document analysis method identified processes key to developing geriatric surgical co-management and advancing complex interdisciplinary programs for older adults.