Age-Friendly Health Systems Initiative
Working with the Institute for Healthcare Improvement, the American Hospital Association, Catholic Health Association of the United States, and five pioneering health systems, we successfully prototyped the “4Ms” Framework for age-friendly care—What Matters, Medication, Mentation, and Mobility. We set a bold goal to spread 4Ms evidence-based best practices to 20 percent of U.S. hospitals and health systems by 2020.
In 2018, we launched the first Age-Friendly Health Systems Action Community. The seven-month virtual learning experience allows teams from any health care setting—such as the emergency department (ED), a hospital unit, primary care clinic, or skilled nursing facility—to receive coaching and tools for improving care. The teams generously share data and learnings with each other.
More than 125 teams from over 75 health systems enthusiastically joined the first Action Community. We’ve seen rapid results:
- Systems are asking their older patients What Matters and integrating that into the electronic health record so that goals of care are followed.
- Simple changes, such as switching water containers at the hospital bedside, are helping older adults drink more fluids to reduce the risk of delirium and Mentation problems.
- Mobility plans are in place and Medications are being de-prescribed, resulting in decreased length of hospital stay.
The second Action Community launches in 2019 and another 150 teams have already signed on.
Hospital at Home®
Most people want to avoid hospitalization whenever possible. Not only is it inconvenient and frightening to be admitted, but it is risky given the hazards associated with hospitalization.
Hospital at Home® provides hospital-level care in a patient’s home as a safe and cost-effective substitute for acute hospital care. We augmented a federal award to deliver and evaluate a version of Hospital at Home developed by the Icahn School of Medicine at Mount Sinai, which bundles hospital-at-home care with a 30-day period of home-based transitional care. Working together we are setting the program up for a Medicare payment model so that more people can get this care.
Results of the evaluation, published in JAMA Internal Medicine in August 2018, were promising. Compared with patients receiving inpatient care, those receiving hospital-at-home care had:
- Shorter length of stay
- Lower rates of 30-day hospital readmission, emergency department visits, and skilled nursing facility admissions
- Better ratings of care
Watch a video about Hospital at Home® featured on NBC Nightly News in 2018.
Geriatric ED Initiatives
Americans aged 65 and older enter emergency departments (EDs) at higher rates than those who are younger, and will make up an increasing share of ED visits in the years to come. Assessing and improving the delivery of care at this common entry point into our health care system will result in less harm, better outcomes, and more satisfied patients.
In partnership with the West Health Institute, we launched the Geriatric Emergency Department Collaborative (GEDC) to evaluate best practices, transform care, and spread learnings about how to provide the best emergency care to older adults. It coordinates nine EDs, four national organizations, and interdisciplinary faculty who study geriatric ED interventions, provide online curriculum, and help train EDs.
In 2018, the American College of Emergency Physicians established the Geriatric Emergency Department Accreditation (GEDA) program, which provides standards and guidance for EDs and indicates to the public that the accredited institution is focused on providing high standards of quality care.
As of December 31, 2018, 25 institutions were already accredited.
Findings from a study of GEDC sites participating in a prior federal program were published in March 2018. As written about in JAMA Forum, older adults seen by a nurse who coordinates the transition from ED to home were less likely to be admitted to the hospital than those who did not.
Watch a video about how GEDA-certified St. Joseph Medical Center and St. Mary’s Medical Centers in Kansas City are improving care for ED patients.
