Age-Friendly Health Systems
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Age-Friendly Health Systems provide care to older Veterans based on What Matters. The 4Ms (What Matters, Medication, Mentation, and Mobility) are a framework to provide Veteran-centric care focused on What Matters across all care settings. Age-Friendly Health Systems is a high-reliability approach to continuously improve care and achieve zero harm.
April 2017, Institute for Healthcare Improvement
61 successful, 53 in-progress
Key Components of Age-Friendly Care
Recommendations for Making Care More Age-Friendly
- Number of patients 65+ who receive 4Ms care. In progress= IHI participant recognition in 1+ care setting. Successful=Committed to Care Excellence recognition in 1+ care setting.
Does not include Clinical Resource Hubs (CRH)
What is an Age-Friendly Health System?
Understand your current stateFirst, conduct a current state assessment at your facility. Identify where the 4Ms are already in practice. Where are your bright spots? Who are your champions?Select a care setting where you’d like to get started. Questions to consider: How many older Veterans are served in this care setting? Is there a local champion? Can this setting be a model for the rest of the hospital/health care system? Are there team members who have experience with the 4Ms, either individually or combined? Do you already have processes and tools in place to support the 4Ms? Once you’ve selected a care setting, set up your Age-Friendly team.
Create a 4Ms planUsing the 4Ms Care Description Worksheet, describe a plan for how your team will provide care consistent with the 4Ms. This worksheet helps you to assess, document, and act on the 4Ms as a set, while customizing the approach to practicing the 4Ms for your context. As you test the 4Ms, you may make updates to your 4Ms plan based on what you learn about the tools and methods that work best for your team. Questions to consider: How does your current state compare to the actions outlined in the 4Ms Care Description Worksheet? Which of the 4Ms do you already practice? How reliably are they practiced? Where are there gaps in 4Ms? What ideas do you have to fill the gaps? Once you've create a 4Ms plan, you can provide this information in a brief online survey to IHI to achieve Age-Friendly Participant recognition.
Design and adapt your workflowLook for opportunities to combine or redesign activities, processes, and workflows around the 4Ms. In this effort you may find that you can stop certain activities and shift resources to support Age-Friendly care.
Provide careLearn as you move toward reliable 4Ms care. Begin to test the key actions described in your 4Ms plan with one older Veteran and their family or other caregivers. Use the Plan-Do-Study-Act (PDSA) process to learn more from your tests and improve 4Ms care. Scale up your tests to include more Veterans and modify your 4Ms plan if needed.
Study your performanceHow reliable is your 4Ms care? What impact does your 4Ms care have? Directly observe your 4Ms plan in action. Can your team follow the 4Ms Care Description and successfully assess and act on the 4Ms with the older Veteran in your care? Does the Veteran’s care plan reflect 4Ms care? Consider asking your team at least once per month for the first seven months of your efforts, two open-ended questions and reflect on the answers: What are we doing well to assess and act on the 4Ms? What do we need to change to translate the 4Ms into more effective care? Consider asking your Veterans and their families or caregivers two open-ended questions and reflect on the answers: What went well in your care today? What could we do better to understand what Age-Friendly care means to you?
Improve and sustain careAs you establish Age-Friendly care at your facility, you may cycle through these steps many times over the course of several months in order to achieve reliability and then turn your efforts to sustainability and monitoring (quality control) over time. Begin measuring the number of Veterans over age 65 who receive 4Ms care. To achieve Committed to Care Excellence recognition, teams need to provide three months of counts for the number of older adults receiving all 4Ms (as described in the 4Ms Care Description submitted to IHI for Participant recognition).
- Primary care
- Physical medicine and rehabilitation
- Whole health
- Social work
- Extended care and rehabilitation
- Hospital medicine
- Mental health care
- Emergency care
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- Link to 4Ms Care Description Worksheets to earn Age-Friendly Health Systems Participant recognition Recognition
- http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/Join%20the%20Movement.aspx Join the movement
- HSR article on Age-Friendly in VHA Age-Friendly Health Systems: Improving care for older adults in the Veterans Health Administration
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Email firstname.lastname@example.org with questions about this innovation.
Kim Church, MS
National Lead for Age-Friendly Health Systems, VHA Office of Geriatrics and Extended Care
Marianne Shaughnessy, PhD, CRNP
Director, Geriatric Research Education Clinical Centers (GRECCs)
Tom Edes, MD
Senior Medical Advisor, VHA Office of Geriatrics and Extended Care
Laurence Solberg, MD AGSF
Geriatrician, North Florida/South Georgia Veterans Health System, Gainesville GRECC
Troy.email@example.com Strategic Planner looking for assistance to adopt this at a rural Healthcare System
@Troy - email coming your way!
This is an exciting movement and our office, Diffusion of Excellence, hopes to help spread the word!