Improving Care Quality, Safety, and Outcomes for Older Adults
By Marie Cleary-Fishman, BSN, MS, MBA, CPHQ, CPPS, CHCQM
Vice President, Clinical Quality, The Center for Health Innovation, American Hospital Association
ABQAURP Diplomate and 43rd Annual Conference Faculty
In the U.S., the population of older adults with complex healthcare needs is growing rapidly. While the total U.S. population rose 9.7% between 2000 and 2010, the population of adults 65 and older rose 15.1% (Werner, 2011). One factor influencing this demographic shift is increasing life expectancy: On average, men reaching age 65 today can expect to live until age 84, and women reaching age 65 today can expect to live, on average, to age 86 (Social Security Administration, 2020).
For older adults, healthcare can be complicated. They are more likely to experience duplication of services, multiple transitions between care settings, harm from medications, and lack of planning that incorporates the goals of patients and their families. And according to the U.S. Department of Health and Human Services (2016), approximately 70% of the 65-and-older population will need long-term care at some point in their lives. The U.S. healthcare delivery system needs to be adequately prepared to support the growing population of older adults.
4Ms Framework addresses older adults’ care needs
This is why the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the AHA and the Catholic Health Association of the United States, have launched the Age-Friendly Health Systems initiative. It is designed to improve patient safety and outcomes, increase patient and family engagement, and reduce the length of stay and readmissions for older adults. Participating healthcare organizations use an evidence-based model that focuses on the 4Ms Framework: what matters, medications, mentation, and mobility.
Many care sites—such as hospitals, health systems, physician clinicians, and ambulatory settings—have implemented the 4Ms Framework. Age-friendly care teams assess their current workflows to understand which processes can be eliminated or improved, with guidance from the 4Ms. These teams use evidence-based practices to enhance quality, efficiency, and the patient and family experience.
Here are a few examples of their work and results:
Improved care quality and outcomes. Understanding an older adult’s healthcare goals is essential in developing their customized care plan, and this is achieved by asking a patient “What Matters?” Anne Arundel Medical Center (AAMC) in Annapolis, Maryland, incorporated “What Matters” into their care plans for older adult patients by transforming white boards into “What Matters” boards and integrating that data into electronic health records. The medical center also established age-friendly champions, who facilitate daily exercise for older patients and have improved care coordination. Through multiple interventions, including their age-friendly work, AAMC has reduced readmission rates and length of stay for older adult patients. AAMC realized that what matters to patients is to have time to do what is most important to them; by reducing hospital length of stay, readmission rates, and emergency department stays, AAMC gave cumulatively the equivalent of 10 years of time to their patients (American Hospital Association, 2019; Huddle For Care, 2018).
Better value. Using evidence-based practices aligned with the 4Ms enhances quality of care and reduces adverse events among older adults. This means better health outcomes for patients and reduced care costs for providers and patients. For patients with delirium, length of stay can be 20%–30% longer than those without delirium (HealthLeaders, 2019). At Hartford Hospital in Connecticut, patients with delirium stay 12 days on average, costing $31,284, while those without delirium stay for four days, costing $8,900. Through the hospital’s Actions for Delirium Assessment Prevention and Treatment (ADAPT) program, which is integrated with the 4Ms, screening, treating, and managing cases of delirium generated a $3.6 million return on a $2.4 million investment (HealthLeaders, 2019).
Better patient and family experience. The Trinity Health System, based in Livonia, Michigan, has multiple sites engaged in age-friendly care, including hospice. Staff members found that some of the things that improve care quality are not clinical at all. When one hospice patient was asked, “What matters most to you today?” it was discovered that all she wanted was an ice cream cone. Staff realized that they had to make changes to give the best care and achieve the best outcomes for their patients.
The Age-Friendly Health Systems initiative empowers teams in hospitals and other health settings to provide age-friendly care (American Hospital Association, 2018). One leader in this work, Denise Lyons, program manager of Christiana Care’s Nurses Improving Care for Health System Elders (NICHE), explains, “We knew it was the right thing to do for our patients.” This work has the potential to optimize care and value for all: patients, families, caregivers, healthcare providers, and the overall system.
Visit the American Hospital Association’s website for more information: www.aha.org/center/new-payment-and-delivery-models/age-friendly-health-systems
American Hospital Association (2018). Building an age-friendly health care system. https://www.aha.org/newdeliverymodels/articles/building-an-age-friendly-health-care-system
American Hospital Association (2019). Creating age-friendly health systems. https://www.aha.org/system/files/media/file/2019/08/AHA_Creating_ Age-Friendly_Health_Systems_8.1.19.pdf
HealthLeaders (2019). Improve health of seniors with 4-pronged, age-friendly strategy.
Huddle for Care (2018). Deploying the 4Ms to improve outcomes and health experiences for older adults. https://www.huddleforcare.org/story/deploying-the-4ms-to-improve-outcomes-and-health-experiences-for-older-adults
Social Security Administration (n.d.). Life expectancy calculators. www.ssa.gov/planners/lifeexpectancy.html
U.S. Department of Health and Human Services. The basics. www.longtermcare.gov/the-basics
Werner, C. (2011). The older population: 2010. 2010 Census Briefs. https://www.census.gov/prod/cen2010/briefs/c2010br-09.pdf