Editor’s note: The John A. Hartford
Foundation, the Administration for Community Living and The SCAN Foundation
fund the Aging and Disability Business Institute (www.aginganddisabilitybusinessinstitute.org),
led by the National Association of Area Agencies on Aging (n4a). The mission
of the Aging and Disability Business Institute is to build and strengthen
partnerships between aging and disability community-based organizations (CBO)
and the healthcare system. As partners in the Aging and Disability Business
Institute, ASA and n4a are collaborating on a series of six articles and case
studies in Aging Today that highlight the Age-Friendly Health Systems
initiative.
Aging-sector professionals have spent decades
developing care models to ensure that older adults can live better lives,
producing copious evidence to show what strategies work best. Despite these
efforts, U.S. healthcare delivery remains uneven. In every healthcare care
organization there are providers who dispense stellar care, while others don’t
use evidence-based best practices, providing care that can be harmful to older
adults.
In 2016, The John A. Hartford Foundation and
the Institute for Healthcare Improvement (IHI), in partnership with the
American Hospital Association (AHA) and the Catholic Health Association of the
United States (CHA), launched the Age-Friendly Health Systems (AFHS) initiative
to address this problem. That initiative, according to Amy Berman, a senior
program officer at The John A. Hartford Foundation, has now become more of a
movement, due to its overarching vision and scope.
From Myriad Models to the 4Ms
The partnership members examined all of those
evidence-based care models produced over the years, distilling from them 90
model features and ending up with 13 that are crucial to delivering good care.
Gathering feedback from researchers who built the models, health system leaders
and older adults and their caregivers, the list of features was narrowed down,
identifying a framework to organize care that would best improve care for older
adults, would best reflect what is most important to older adults and would
best provide strong outcomes for health systems.
The framework, boiled down to four critical
elements to great care, is now referred to as the 4Ms: What Matters to older
adults (knowing and aligning care with each older adult’s specific health
outcome goals and care preferences including, but not limited to, end-of-life
care, and across settings of care); Medication (if medication is necessary,
using age-friendly medication that does not interfere with What Matters to the
older adult, Mobility or Mentation across settings of care); Mentation
(preventing, identifying, treating and managing delirium, dementia and depression
across care settings); and Mobility (ensuring that each older adult moves
safely every day to maintain function and do What Matters).
The 4Ms are the founding principles upon which
the larger Age-Friendly Health Systems movement is based. The movement’s work
occurs in a range of settings, from the hospital, to outpatient care, within
PACE facilities and via community-based supports and services (area agencies on
aging also support this work).
Implementing the 4M process begins with
talking with older adults to discover what matters most to them, and then
screening for medication, mentation and mobility. “It’s really about how we
weave together all existing resources, across the continuum of care, to support
people to live better lives, to get better healthcare and make all [settings]
age-friendly,” says Berman.
Health Systems Embrace the Initiative
Five pioneering health systems—Anne Arundel
Medical System; Ascension; Kaiser Permanente; Providence St. Joseph Health; and
Trinity Health—signed on to prototype the process for implementation of the
4Ms. IHI leads the national work in partnership with AHA and the CHA. Together
they are convening seven-month Action Communities for health systems to implement
and become age-friendly (see the article about Action Communities on page 14,
or visit tinyurl.com/yx8mm593).
The 4Ms may be implemented differently
depending upon a health system’s structure and resources; for example,
Ascension has built the 4Ms approach into their annual wellness visits, implementing
it with 10,000 of their older patients. Ascension saw that the process helps
both clinicians and patients to focus on what’s most important, best tailoring
care to address patients’ goals.
“Essentially, health systems are taking what
they are already doing well and building it out so age-friendly care is
reliably delivered at every interaction,” says Berman.
For now, the 4Ms are being incorporated into
care in more than 300 sites across the country, with 162 hospitals and
healthcare practices receiving formal recognition by IHI
(tinyurl.com/y4j5pmz8). The Centers for Medicare & Medicaid Services also
has included AFHS education and training in the AHA’s Hospital Innovation
Improvement Network, which contains 1,638 hospitals. And the Health Resources
and Services Administration approved a $175 million Geriatric Workforce Enhancement
Program over the next five years to train the primary care workforce in
age-friendly care. Also CVS MinuteClinic (the nation’s largest retail primary
care provider with 1,100 MinuteClinics) will roll out this age-friendly care
work across their system beginning in 2020.
Outcomes Data Drive Quality Care
The AFHS Guide To Using the 4Ms in the Care of
Older Adults (tinyurl.com/y2oxwxsf) includes instructions on outcomes
measurement, which can document if the 4M work has resulted in improved
care and, if so, can see if the initiative succeeded in reducing 30-day
readmission rates and emergency department use, and if it elevated patients’
satisfaction with their care.
The John A. Hartford Foundation and IHI, in
partnership with the AHA and the CHA, created a bold vision in 2017, aiming to
ensure that “all care with older adults is age-friendly care.” Considering the
number of health systems and community-based organizations already working with
the 4Ms framework, it seems that the partners are beginning to realize a vision
for Age-Friendly Health Systems.
For information about becoming an Age-Friendly
Health System or participating in an Action Community, visit www.ihi.org/agefriendly.
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