INTRO: The increase in the number of older adults in the United States is unprecedented. By 2040, the number of older adults is expected to reach 80.8 million. Aging increases the risk of chronic diseases and comorbidities. More than 50% of hospitalized patients in Advocate Health are older adults. It is our commitment to provide excellent clinical care for older adults. The Age-Friendly Health System provides a framework of a set of four evidence-based elements of high-quality care, the “4Ms,” What Matters, Medication, Mentation, and Mobility to improve patient outcomes.
Advocate Health is working on quality improvement efforts utilizing the 4Ms framework to improve care for older adults and increase our patient experience scores for this vulnerable population.
GOAL: Systematically implement the Age-Friendly 4Ms framework in 25 hospitals and achieve Committed to Care Excellence recognition for all 25 hospitals by 2025.
IMPLEMENTATION PLAN: Our Age-Friendly inpatient implementation began with six hospital sites that were identified as pilot sites. These pilot sites enabled Advocate Health to complete a system gap analysis on the 4Ms framework. This identified opportunities for improvement and set the Advocate Health system standards for Age-Friendly 4Ms implementation.
The plan includes a total of six Cohorts to participate in the IHI/AHA Fall or Spring Action Community and implement Age-Friendly 4Ms at their sites.
- Assessment of Advocate Health’s 4Ms care
- Standardization of the assessment/acting on 4Ms care in our system
- Age-Friendly Participant Recognition- 5 Clinics/9 Hospitals
- Committed to Care Excellence Recognition- 5 Clinics/6 Hospitals
- EPIC Build- What Matters Most
- EPIC Optimization- Mentation Screenings
- Created system Age-Friendly Data Dashboard
- Created Advocate Health system 4Ms Implementation Guide
- Created Automated Audit Tool
- Created system education on implementation of the 4Ms
- Created a sustainability plan
OPPORTUNITY: What Matters Most was identified as our biggest opportunity, as there was not a process in place to assess, document, and act on What Matters Most. Additionally, there was a need across our system to improve patient experience scores for the older adult population 65+. Assessing and incorporating What Matters Most into care delivery provided a solution to improve patient experience.
In response, we worked with our pilot sites to identify the workflow and where this would best live within our electronic health record so that every discipline would be able to:
- Verify What Matters Most to the patient, and
- Incorporate that into the care they provide. We also created and embedded scripted questions to not only guide teammates in the assessment of What Matters Most but also to standardize this across our system.