Age-Friendly Health Sys­tems Trans­form Care for Older Adults

Pa­tient sat­is­fac­tion and cost-ef­fec­tive­ness are at the heart of the move­ment

Modern Healthcare - - News - Terry Ful­mer Pres­i­dent The John A. Hart­ford Foun­da­tion

The Age-Friendly Health Sys­tems ini­tia­tive of The John A. Hart­ford Foun­da­tion and the In­sti­tute for Health­care Im­prove­ment, in part­ner­ship with the Amer­i­can Hospi­tal As­so­ci­a­tion and the Catholic Health As­so­ci­a­tion of the United States, sup­ports the de­liv­ery of ev­i­dence-based, high-qual­ity care to older adults in ev­ery care set­ting. More than 75 health sys­tems na­tion­wide have joined the move­ment to de­liver care to older adults in ways that meet their goals and pref­er­ences, while in­creas­ing sat­is­fac­tion and cost­ef­fec­tive­ness.

What are Age-Friendly Health Sys­tems?

TF: The Age-Friendly Health Sys­tems ini­tia­tive is built around four es­sen­tial, in­ter­re­lated el­e­ments that guide health care in­ter­ac­tions with older pa­tients. The first is what mat­ters to the pa­tient. Sys­tems should know and align care with older pa­tients’ spe­cific health goals and care pref­er­ences. The next el­e­ment is men­ta­tion. Core to this is pre­vent­ing, iden­ti­fy­ing, treating, and manag­ing de­men­tia, de­pres­sion, and delir­ium in older pa­tients across care set­tings. The third el­e­ment is mo­bil­ity, en­sur­ing older adults move safely ev­ery day to main­tain func­tion and do what mat­ters to them. The last el­e­ment is med­i­ca­tion. If med­i­ca­tion is nec­es­sary, clin­i­cians should pre­scribe age­friendly med­i­ca­tions that don’t in­ter­fere with what mat­ters to the pa­tient, nor af­fect their mo­bil­ity or men­ta­tion. Depre­scrib­ing is es­pe­cially im­por­tant when­ever pos­si­ble. Taken to­gether, we call these the “4Ms.”

Who’s in­volved in the move­ment?

TF: Our mis­sion at The John A. Hart­ford Foun­da­tion is to im­prove care for older adults, and for over three decades, we’ve helped build the ev­i­dence base for bet­ter geri­atric care. In 2015, we started dis­cussing the con­cept of age­friendly health sys­tems to meet the ag­ing pop­u­la­tion’s needs. The “age-friendly” moniker is glob­ally rec­og­nized by the World Health Or­ga­ni­za­tion and it made sense to build on and align with that work. It was clear from the be­gin­ning that we needed a strong part­ner in care qual­ity and the dif­fu­sion of best prac­tices. The ob­vi­ous choice was the In­sti­tute for Health­care Im­prove­ment (IHI). Our goal in part­ner­ing with IHI’S ex­perts is to en­sure older pa­tients ben­e­fit from those best prac­tices, no mat­ter where they get care, and to reach 20 per­cent of U.S. health sys­tems by 2020.

We’re also part­ner­ing with the Amer­i­can Hospi­tal As­so­ci­a­tion (AHA) and the Catholic Health As­so­ci­a­tion of the United States (CHA) to bring ev­i­dence-based best prac­tices into care set­tings across the coun­try. In 2017, five ma­jor sys­tems signed on as pioneer Age-Friendly Health Sys­tems: Anne Arun­del Med­i­cal Cen­ter, As­cen­sion, Kaiser Per­ma­nente, Prov­i­dence St. Joseph Health, and Trin­ity Health. These sys­tems helped iden­tify and test best prac­tices and learn what it takes to be part of the move­ment.

In 2018, to­gether with IHI, AHA, and CHA, we launched the first Age-Friendly Health Sys­tems Ac­tion Com­mu­nity. We’ve wel­comed 125 teams from more than 75 health sys­tems to this vir­tual learn­ing com­mu­nity. Each ex­plores the 4Ms frame­work in their hospi­tal and am­bu­la­tory set­tings and gen­er­ously shares data and learn­ings. Our sec­ond Ac­tion Com­mu­nity is ac­cept­ing par­tic­i­pants and will launch in April 2019.

What progress has the ini­tia­tive achieved?

TF: The Age-Friendly Health Sys­tems ini­tia­tive wants to make sure that the 4Ms are present at ev­ery touch­point of a pa­tient’s care—whether it’s in the home, hospi­tal, emer­gency room, long-term care fa­cil­ity, or am­bu­la­tory clinic—be­cause care must be seam­less.

The ways to mea­sure progress are myr­iad. At Anne Arun­del Med­i­cal Cen­ter, they’ve quan­ti­fied the amount of time the sys­tem gives back to their older pa­tients through early dis­charges and re­duced avoid­able read­mis­sions. They’re giv­ing real time back to their pa­tients to do the things they want to do in­stead of be­ing in the hospi­tal.

One last point to make is that we live in an ever-shift­ing health care par­a­digm. In the 20th cen­tury, health care fo­cused on longevity and treating what­ever ailed pa­tients— and we dou­bled the av­er­age life­span. Now, our think­ing must evolve to con­sider not just what’s the mat­ter with the pa­tient, but what mat­ters to the pa­tient. I’m con­vinced that re­gard­less of size or cir­cum­stance, ev­ery sys­tem, and ev­ery sys­tem leader, can ben­e­fit from learn­ing more about the Age-Friendly Health Sys­tem move­ment. It’s what pa­tients and fam­i­lies have been ask­ing for; it’s what the fu­ture needs to be.

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