Background: Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective healthcare interventions in both primary and secondary care. Method: One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. Results: The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. Conclusions: These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.

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Suzanne, an elder of The Osage Nation, has been diagnosed with basal cell carcinoma, squamous cell carcinoma, and melanoma skin cancer. Her daughter, Bobbie, a cancer researcher working for the Youth Enjoy Science Research Education Program, conducted a case study to share Suzanne's story through written narrative and a series of images that present Suzanne's reflections on cancer prevention and treatment from a holistic perspective. Seven interview transcripts, as well as photographs, drawings, and paintings of Suzanne, were created and analyzed to explore Suzanne's lived experience of cancer. In her story of living with cancer, Suzanne shares an elder's love and wisdom that can inform cancer education and prevention efforts to help address Native American cancer disparities.Native Americans Do Get Skin Cancer Nearly 1 of 10 Native Americans (NAs) believe that Native peoples do not develop skin cancer, and nearly 9 of 10 have been sunburned at least once. 1 Melanoma skin cancer among NAs is less common than among whites 2 ; however, only 1 of 10 NAs report using sunscreen regularly on their bodies, 1 and skin cancer among NAs often goes underdiagnosed until more advanced stages. 2 NAs' perceptions of their low risk of skin cancer, coupled with limited access to health care services, could contribute to the finding that, historically, NAs have made significantly fewer office visits to a dermatologist than whites. 3 Scholars and practitioners recommend increasing public awareness and public health education and improving screening and early detection to prevent cancer. 4 In an effort to raise the NA index of suspicion and increase efforts to prevent skin cancer among NAs, we share Suzanne's story through written narrative and portraits as a case study exploring one NA woman's lived experience of skin cancer.Suzanne, an elder of The Osage Nation who resides in Tulsa, Oklahoma, has spent the majority of her life outdoors, in the water and under the sun. Suzanne grew up in the Great Plains near the Osage ancestral lands, surrounded by rivers and lakes. She loved to swim and embodied the Osage sacred name "children of the middle waters." Suzanne's daughter, Bobbie McWilliams, citizen of The Osage Nation, an undergraduate fine arts major/Native American studies minor and a Youth Enjoy