Age-Friendly Health Systems in an Ecosystem Perspective

Fulmer, Terry; Pelton, Leslie; Zhang, Jinghan; Huang, Wendy Y.

doi:10.1007/978-3-030-01782-8_122-1

Cited by 5 publications

(19 citation statements)

References 21 publications

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“…For example, the Medication domain of the framework focuses on avoiding prescribing (or deprescribing) a set of high-risk medications with known side effects in older adults such as increased risk of falls, fatigue, and memory problems. 9 In practice, the Medication domain could be approached in varied ways, such as through pharmacist-led medication reviews or prescriber-targeted medication decision support. Even when an approach to the 4Ms is defined, the associated frontline practices can be varied (e.g., use of multiple different cognitive screening tools [10][11][12] ).…”

Section: Introductionmentioning

confidence: 99%

Health system approaches and experiences implementing the 4Ms: Insights from 3 early adopter health systems

Adler‐Milstein,

Krueger,

Rosenthal

et al. 2023

J American Geriatrics Society

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Background Redesigning the healthcare system to consistently provide effective and tailored care to older adults is needed. The 4Ms (What Matters, Mobility, Medication, and Mentation) offer a framework to guide health systems' efforts to deliver Age‐Friendly care. We use an implementation science framework to characterize and assess real‐world implementation experiences with the 4Ms across varied health systems. Methods With expert input, we selected three health systems that were early adopters of the 4Ms and engaged in different implementation support models through the Institute for Healthcare Improvement. We conducted 29 semi‐structured interviews with diverse stakeholders from each site. Stakeholders ranged from hospital leadership to frontline clinicians. Interviews covered each site's approach to and experiences with implementation, including facilitators and barriers. Interviews were recorded, transcribed, and deductively coded using the Consolidated Framework for Implementation Research. We characterized each site's implementation decisions and then inductively identified overarching themes and subthemes with supporting quotes. Results Health systems varied in their implementation approach, including the implementation order of each of the 4Ms. We identified three overarching themes: (1) the 4Ms offered a compelling conceptual framework for advancing Age‐Friendly care, but implementation was complex and fragmented; (2) complete and sustained implementation of the 4Ms required multidisciplinary and multilevel leadership and engagement; (3) strategies that facilitate implementation success and support frontline culture change included top‐down communication and infrastructure alongside hands‐on clinical education and support. Common barriers are siloed implementation efforts across settings that impeded synergies and scaling; disengaged physicians; and difficulty implementing What Matters in a meaningful way. Conclusions Similar to other implementation studies, we identified multifactorial domains impacting 4Ms implementation. To achieve Age‐Friendly transformation, health systems must plan for and attend to multiple phases of implementation while ensuring that the work coheres under a unified vision that spans disciplines and settings.

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Section: Introductionmentioning

confidence: 99%

Health system approaches and experiences implementing the 4Ms: Insights from 3 early adopter health systems

Adler‐Milstein,

Krueger,

Rosenthal

et al. 2023

J American Geriatrics Society

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“…Hospital systems need to shift from competing for the same nursing staff to identifying practical and innovative ways to respond to the needs and concerns of nurses. While multiple factors need to be addressed to alleviate the nursing workforce crisis and ultimately nurse burnout, 11 the FNAM initiative has 2 following major aims:…”

Section: Factors That Influence the Current State Of The Nursing Work...mentioning

confidence: 99%

The Faculty Nurse Attending Model at the Mount Sinai Hospital

Cartwright

Oliver

Ambrosia

et al. 2023

Nursing Administration Quarterly

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The ongoing nursing shortage and the ravages of the COVID-19 pandemic have further challenged nursing staff with devastating shortages. This article describes the Faculty Nurse Attending Model, an innovative approach incorporating nursing faculty into staffing and the ongoing interdisciplinary rounds at the Mount Sinai Hospital in New York City. The Mount Sinai Phillips School of Nursing faculty actively participates in the pilot unit to support nursing practice and ensure that the curricula address contemporary practice.

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“…Older patients have high rates of health services utilization-including physician office visits, hospitalizations, and nursing home use-and thus represent an important patient population for any health system, especially those participating in risk or valuebased payment models. 6 Second, the AFHS initiative offers a playbook to help providers and systems adopt the 4Ms framework, 4 which could speed a health system's efforts to start the iterative cycles of an LHS. It offers tools for a health system's informaticians and data scientists to integrate data collection related to the 4Ms into the electronic health record (EHR).…”

Section: Opportunities For Synergy Between Afhs and Lhsmentioning

confidence: 99%

“…The compelling case for integrating AFHS and LHS can be conceptualized through Age-Friendly Learning Health Systems (AF-LHS), drawing on the best of both models above. An AF-LHS would pair the measurement model of AFHS with LHS' robust use of user-centered design experts, behavioral economists, and implementation scientists to ensure effective, feasible, and acceptable interventions are A successful age-friendly health system is one where the 4Ms "guide all care of older adults wherever and whenever they come into contact" with the health system 4 A successful learning health system is one that is "designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider" 2 implemented and sustained. AF-LHSs stand as a promising model for catalyzing improved clinical care for older adults, and for catalyzing the implementation of both individual care models.…”

Section: Opportunities For Synergy Between Afhs and Lhsmentioning

confidence: 99%

“…Second, the AFHS initiative offers a playbook to help providers and systems adopt the 4Ms framework, 4 which could speed a health system's efforts to start the iterative cycles of an LHS. It offers tools for a health system's informaticians and data scientists to integrate data collection related to the 4Ms into the electronic health record (EHR).…”

Section: Opportunities For Synergy Between Afhs and Lhsmentioning

confidence: 99%

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