<scp>Age‐friendly</scp> learning health systems: Opportunities for model synergy and care improvement

Prusaczyk, Beth; Burke, Robert E.

doi:10.1111/jgs.17901

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…Between 2017 and 2022, more than 2900 care delivery sites in 49 U.S. states engaged with IHI to become recognized as AFHS sites 4,5 . To receive AFHS recognition, an institution must adopt a set of evidence‐based practices that promote achievement of wellness and functional capabilities referred to as the 4Ms Framework: What Matters, Mobility, Medication, and Mentation 4–8 …”

Section: Introductionmentioning

confidence: 99%

“…4,5 To receive AFHS recognition, an institution must adopt a set of evidence-based practices that promote achievement of wellness and functional capabilities referred to as the 4Ms Framework: What Matters, Mobility, Medication, and Mentation. [4][5][6][7][8] Real-world implementation of the 4Ms requires closing the evidence-to-practice gap by translating the framework into a specific set of changes to the daily work of frontline clinicians (Table S1). 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.…”

Section: Introductionmentioning

confidence: 99%

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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%

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

View full text Add to dashboard Cite

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“…Finally, they can advance efforts to more robustly establish the relationship between practice of the 4Ms and clinical and cost outcomes, 6 which will grow the evidence base and strengthen the essential case for ongoing health system investment. 11…”

Section: Introductionmentioning

confidence: 99%

“…They can be assessed in more nuanced ways, such as whether specific units or patient populations feature lower adherence and may require more tailored approaches or additional resources to achieve high levels of adherence. Finally, they can advance efforts to more robustly establish the relationship between practice of the 4Ms and clinical and cost outcomes, 6 which will grow the evidence base and strengthen the essential case for ongoing health system investment 11 …”

Section: Introductionmentioning

confidence: 99%

Developing electronic health record‐based measures of the 4Ms to support implementation and evidence generation for Age‐Friendly Health Systems

Thombley,

Rogers,

Adler‐Milstein

2023

J American Geriatrics Society

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BackgroundTo support implementation of the 4Ms framework and more rigorous evidence of 4Ms impact, we translated Institute for Healthcare Improvement's (IHI's) recommended 4Ms routine care practices into electronic health record‐based, encounter‐level adherence measures and then implemented measures at a large academic medical center.MethodsWe started with the 19 care practices in IHI's 4Ms implementation guide and developed encounter‐level adherence measures using structured EHR data. We also developed overall 4Ms‐level and M‐level composite measures. Next, we operationalized measures at UCSF Health—an academic medical center that has implemented the 4Ms using the IHI guide. We identified UCSF Health patients who should have received 4Ms care during their inpatient admission (19,335 individuals 65 years and older with an admission between January 1, 2019 and December 31, 2021), then implemented the individual measures and composite measures (all at the encounter level) using Epic EHR data. We focused on 4Ms inpatient care processes, but similar approaches can be followed for ambulatory, post‐acute, and other settings.ResultsWe developed 18 EHR‐based measures that captured all IHI care practices, 16 of which could be implemented using UCSF Health EHR data. For example, the EHR‐based measure for the Medication care practice “deprescribe high risk medications” was measured using EHR data as “Patient had no previously existing prescriptions for high‐risk medications OR patient had ≥1 previously existing prescriptions for high‐risk medications deprescribed during the encounter,” and 29.5% of UCSF Health encounters met this measure. For composite measures, on average, UCSF Health encounters had 61.1% adherence to the 4Ms (SD = 14.4%), with the lowest average adherence to What Matters (50.9%; SD = 44.3%) and the highest for Mentation (68.4%; SD = 13.4%).ConclusionsIt is feasible to construct encounter‐level measures of 4Ms adherence using EHR data and derive insights to guide ongoing implementation efforts. Future efforts should refine measures based on assessments of reliability and validity.

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Age-Friendly Health Systems and the Geriatric 5Ms: Frameworks for Teaching Geriatrics

Schwartz,

Holliday,

Molnar

2024

Medical Education in Geriatrics

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Age‐friendly learning health systems: Opportunities for model synergy and care improvement

Cited by 5 publications

References 11 publications

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

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

Developing electronic health record‐based measures of the 4Ms to support implementation and evidence generation for Age‐Friendly Health Systems

Age-Friendly Health Systems and the Geriatric 5Ms: Frameworks for Teaching Geriatrics

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