As hospitals and health systems prepare to care for an aging population, leaders in the field are exploring how to meet the health care needs of older adults. That’s why the John A. Hartford Foundation and Institute for Healthcare Improvement in partnership with the AHA and Catholic Health Association of the United States have launched the Age-Friendly Health Systems initiative, an evidence-based model that focuses on the 4Ms Framework — what matters, medications, mentation and mobility. 

Designed to improve patient safety and outcomes, increase patient and family engagement, and reduce the length of stay and readmissions of older adults, the initiative aims to reach 20% of hospitals and health systems by Dec. 31, 2020. 

Implementing the 4Ms 

In the spring of 2018, Denise Lyons, Christiana Care’s Nurses Improving Care for Healthsystem Elders (NICHE) program manager, attended a NICHE conference where she first learned about the Age-Friendly Health Systems initiative. Institute for Healthcare Improvement leaders were looking to recruit 100 sites of care for the first cohort, and last September, Christiana Care began the seven-month journey to become an age-friendly health system.  

Part of the allure of the framework is that many hospitals and health systems already are working on many of the 4Ms. Christiana Care was working on three of the four Ms and added the “what matters most to patient” element, said Lyons. 

“We knew it was the right thing to do for our patients,” Lyons said. 

She added that it was a natural fit for the health system, since Christiana Care has been focused on geriatrics for the past two decades. “It also aligned well with the mission at Christiana Care — to serve with love and excellence.” 

The power of partnerships and buy-in

To begin, Lyons met with the nursing professional practice council, which was able to shed light on how implementing the 4Ms would work with their current workflow and electronic health record system. 

In addition, by having conversations with patients about what matters to them, members of the care team — from nurses to providers to pharmacists — were able to enter a patient’s room and see on prominently displayed white boards what mattered most to the patient and start a dialogue around it. This helped patients, their families, and staff to have the best possible experience. 

 “Our nurses embraced it because it was all about implementing evidence-based care into their work,” Lyons said. “They felt strongly about the 4Ms, and they could see the value in it.” 

In addition to the nurses, other key stakeholders included Christiana Care’s patient experience department and external affairs team, all of whom supported these efforts from the start. 

To ensure that the organization met its goals, Christiana Care also made implementing the 4Ms Framework part of its strategic planning efforts. 

AHA’s Action Community

The AHA this fall is launching an Age-Friendly Health Systems Action Community offering free monthly webinars, coaching, resources and in-person meeting to help care sites integrate “age-friendly” health care and support the needs of aging communities. Hospitals, health systems and other sites of care that join the initiative will learn how to implement the 4Ms Framework into their work and about the benefits to patients. 

All care for older adults should be age friendly, said Terry Fulmer, R.N., president of The John A. Hartford Foundation and a practicing nurse at Beth Israel Hospital in Boston. 

Best practices for caring for older populations have evolved, and hospitals and health systems can work to improve, which is where the initiative becomes critical, she added. 

“It’s not just a project,” Fulmer said. “It’s a social movement.” 

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