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King SE, Ruopp MD, Mac CT, O'Malley KA, Meyerson JL, Lefers L, Bean JF, Driver JA, Schwartz AW. Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility. J Am Geriatr Soc 2024. [PMID: 39007623 DOI: 10.1111/jgs.19083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs. METHODS A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life-sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre- and post-AFHS implementation (bed days of care [BDOC] 17413) to post-implementation (BDOC 20880). RESULTS Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life-sustaining treatment documentation (82%-96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38-0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%-17.9%) and emergency department utilization (5.3%-2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 (n = 31, scale 1-100) to 81.3 (n = 42). CONCLUSIONS Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.
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Affiliation(s)
- Sarah E King
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Marcus D Ruopp
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Chi T Mac
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Kelly A O'Malley
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
| | - Jordana L Meyerson
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay Lefers
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
- Department of PM&R, Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jane A Driver
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrea Wershof Schwartz
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Tumosa N, Weiss J. Commentary on the Health Resources and Services Administration Geriatrics Workforce Enhancement Program special supplement. J Am Geriatr Soc 2024. [PMID: 38984455 DOI: 10.1111/jgs.19073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024]
Affiliation(s)
- Nina Tumosa
- Division of Medicine and Dentistry (DMD), Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, Rickville, Maryland, USA
| | - Joan Weiss
- Division of Medicine and Dentistry (DMD), Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, Rickville, Maryland, USA
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Lopez RP, Wei A, Locke JR, Plys E. Advanced-Comfort: Usability Testing of a Care Planning Intervention for Nursing Home Residents With Advanced Dementia. J Gerontol Nurs 2023; 49:15-23. [PMID: 37906044 DOI: 10.3928/00989134-20231010-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Many nursing home (NH) residents with advanced dementia receive burdensome interventions rather than interventions that promote comfort or quality of life. The purpose of the current study was to test the usability of a novel intervention, ADVANCED-Comfort, which aims to enhance the provision of personalized care for residents with advanced dementia. The intervention comprises structured care plan meetings between the NH team and proxies of residents with dementia (e.g., family members). Using the ADVANCED-Comfort workbook, proxies create individualized care plans addressing six domains adapted from the Age-Friendly Health System Framework. The purpose of this article is to describe the intervention and its theoretical underpinnings and report the usability of the intervention evaluated with surveys, observation, and exit interviews. The study demonstrated that proxies and NH staff found the intervention usable (acceptable, appropriate, and feasible). Based on these preliminary findings, additional testing of the ADVANCED-Comfort intervention is warranted. [Journal of Gerontological Nursing, 49(11), 15-23.].
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Bhattacharyya KK, Molinari V, Black K, Whitbourne SK. Creating age-friendly nursing homes: The time is now. GERONTOLOGY & GERIATRICS EDUCATION 2023; 44:613-630. [PMID: 35950627 DOI: 10.1080/02701960.2022.2106981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The current global age-friendly movement supports older adults by promoting different policies and services. However, there is a dearth of attention to nursing home (NH) residents as part of age-friendly movements. The pioneering idea of an age-friendly health system, i.e., the "4 Ms" model is significant for NHs and formative for further developments; however, it does not identify unique components of NH care. This article aims to identify specific aspects of person-centered care in the literature to advance the development of a standardized conceptual framework. Along with residents, NH staff and administrators are integral parts of NHs. Incorporating the central role of caregivers, this study proposes a new "8 Ms" framework to describe the age-friendly NH. The traditional 4 Ms model notes that everything related to care matters to residents, along with care related to medication, mobility, and mentation. The proposed age-friendly framework introduces five additional "M," i.e., meaningful care, motivation, moderation, modification, and monitoring. This framework is proposed to advance education, training, clinical practice, research, and advocacy to promote quality of care in NHs. Application of the 8 Ms framework may yield multiple benefits, assuring good quality of care to residents, caregivers' job satisfaction, and supporting NH management in providing residents optimal care.
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Affiliation(s)
- Kallol Kumar Bhattacharyya
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
- College of Nursing & Health Sciences, Bethune-Cookman University, Daytona, Florida, USA
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Kathy Black
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Susan Krauss Whitbourne
- Department of Gerontology, University of Massachusetts Boston, Boston, Massachusetts, USA
- Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Kalsy M, Church K, Bowman E, Mirk A, Olunuga D, Edes T. Shifting Culture Toward Age-Friendly Care: Lessons From VHA Early Adopters. Fed Pract 2023; 40:344-348b. [PMID: 38567299 PMCID: PMC10984684 DOI: 10.12788/fp.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background The need for a health care workforce with expanded skills in the care of older adults is increasingly evident as the US population ages. The evidence-based Age-Friendly Health Systems (AFHS) framework establishes a structure to reliably assess and deliver effective care of older adults with multiple chronic conditions: what matters, medication, mentation, and mobility (4Ms). Half of veterans receiving Veterans Health Administration (VHA) care are aged ≥ 65 years, driving its transformation into the largest AFHS in the US. In this article, we offer lessons on the challenges to AFHS delivery and suggest opportunities to sustaining age-friendly care. Observations Within 3 months of implementation, 85% to 100% of patients received 4M care in all care settings at our VA facilities. Key lessons learned include the importance of identifying, preparing, and supporting a champion to lead this effort; garnering facility and system leadership support at the outset; and integration with the electronic health record (EHR) for reliable and efficient data capture, reporting, and feedback. Although the goal is to establish AFHS in all care settings, we believe that initially including a geriatrics-focused care setting helped early adoption of 4Ms care in the sites described here. Conclusions Early adopters at 2 VHA health care systems demonstrated successful AFHS implementation spanning different VHA facilities and care settings. Successful growth and sustainability may require leveraging the EHR to reduce documentation burden, increase standardization in care, and automate feedback, tracking, and reporting. A coordinated effort is underway to integrate AFHS into VHA documentation, performance evaluation, and metrics in both the legacy and new Cerner EHRs.
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Affiliation(s)
- Megha Kalsy
- Veterans Affairs Northeast Ohio Healthcare System, Cleveland
| | - Kimberly Church
- Veterans Health Administration, Geriatrics and Extended Care, Washington, DC
| | - Ella Bowman
- Oregon Health and Science University, Portland
| | - Anna Mirk
- Veterans Affairs Atlanta Healthcare System, Georgia
| | | | - Thomas Edes
- Veterans Health Administration, Geriatrics and Extended Care, Washington, DC
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Siegel EO, Kolanowski AM, Bowers BJ. A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models. Res Gerontol Nurs 2023; 16:5-13. [PMID: 36692436 DOI: 10.3928/19404921-20230104-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].
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Severance JJ, Rivera S, Cho J, Hartos J, Khan A, Knebl J. A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105903. [PMID: 35627440 PMCID: PMC9141549 DOI: 10.3390/ijerph19105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022]
Abstract
Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems—Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.
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Affiliation(s)
- Jennifer Jurado Severance
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
- Correspondence: ; Tel.: +1-817-735-0469
| | - Solymar Rivera
- Department of Rehabilitation and Health Services Research, University of North Texas, Denton, TX 76203, USA;
| | - Jinmyoung Cho
- Center for Applied Health Research, Baylor Scott & White Research Institute, Temple, TX 76502, USA;
| | - Jessica Hartos
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Amal Khan
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
| | - Janice Knebl
- Department of Internal Medicine and Geriatrics, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.K.); (J.K.)
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Lesser S, Zakharkin S, Louie C, Escobedo MR, Whyte J, Fulmer T. Clinician knowledge and behaviors related to the 4Ms framework of Age-Friendly Health Systems. J Am Geriatr Soc 2021; 70:789-800. [PMID: 34837381 PMCID: PMC9299469 DOI: 10.1111/jgs.17571] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/15/2022]
Abstract
Background The Age‐Friendly Health Systems (AFHS) aims to improve the experience of care for adults aged 65 years and older through the 4Ms framework, an evidence‐based approach to care planning that emphasizes what matters most to the older person, mentation, mobility, and medication. The aim of this study was to examine clinicians' attitudes, knowledge, and practices concerning AFHS and the 4Ms. Methods We surveyed U.S.‐based health care providers randomly identified from the Medscape database. The sample was weighted based on sex, U.S. Census region, and ethnic diversity of health occupations. We examined the differences between cohorts using proportions tests and logistic regression models. Results More than 90% of clinicians (n = 1684) agreed that “older patients require a different approach to care than younger patients.” Fifty percent of clinicians “always” take the age of their patient into consideration when determining care. A majority of clinicians said they discuss each of the 4Ms with older patients and/or their family caregivers. Screening for depression and review of high‐risk medication use are among the leading types of age‐friendly care that clinicians provide to older patients. A minority of clinicians are asking older adults about and aligning the care plan with What Matters. Conclusions A majority of clinicians acknowledged the benefits of providing care via AFHS but reported limited knowledge of the specificities of the 4Ms framework and are not necessarily taking the age of their patients into consideration when determining the best form of care. Health care settings that have implemented the 4Ms framework appear to be doing so in an incomplete way. Our study reinforces the case for training primary care providers on how to adopt the evidence‐based 4Ms framework in clinical practice effectively and consistently.
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Affiliation(s)
| | | | | | | | - John Whyte
- Market Research, WebMD, New York, New York, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, New York, USA
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