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IHI Looks to Expand 'Age-Friendly' Health Systems

Analysis  |  By John Commins  
   December 10, 2019

An age-friendly health system uses an evidence-based framework called the 4Ms to improve outcomes, shorten hospital stays, and meet the expectations of older patients.

ORLANDO — The Institute for Healthcare Improvement (IHI) has joined with the nation's major hospital associations to expand a program that promotes and recognizes providers of "age friendly" care.

The initiative, Age-Friendly Health Systems, uses evidence-based framework called the 4Ms: what matters to older adults; medication that is age friendly; attending to mentation, including delirium, depression, and dementia; and mobility, so seniors can maintain function.

Funded by a $6 million grant from The John A. Hartford Foundation, the initiative is in partnership with the American Hospital Association and the Catholic Health Association of the United States.

Kedar Mate, MD, IHI's Chief Innovation and Education Officer, spoke with HealthLeaders about the initiative at the kickoff of the 31st annual IHI National Forum on Quality Improvement in Health Care, which is happening here in Orlando this week.

"We have a big problem in this country with an aging population," Mate says. "In some communities that we're working with now the growth of the over-65 population is upwards of 80% while every other demographic is shrinking."

"We started with five systems. We didn't give them a cheat sheet on how to do it. They invented it themselves, how to implement the specific care guidelines," Mate says. "From those five systems, two years later, we've now reached 450 healthcare systems, both hospitals and ambulatory practices all over the country."

As of November, 284 hospitals and other care venues have earned the level-one designation as Age-Friendly Health System participants, and Mate says IHI aims to expand age-friendly care to 1,000 hospitals and other healthcare venues by the end of 2020.

Mate says 117 providers have earned level-two designation for exceptional program outreach to older adults over at least three months.

"It's created quite a buzz," he says. "There are some really interesting systems that are taking this under their wing and making it their strategy."

In building the 4Ms framework, Mate says, researchers were surprised to find that solid, evidence-based care models for older adults were already being used in many places.

"Of the 17 highly evidenced models, 13 or 14 of them were in place in systems in total discoordination," he says. "The left hand was not talking to the right hand, that kind of stuff."

The researchers studied the evidence-based models, extracted key ingredients, and spoke with those who initiated the models, Mate says.

"We found that there were 90 different things that these models encompassed," he says. "We distilled them down to 13 different concepts. There were a lot of redundancies, but then we said we can't build a national campaign around 13 things."

"We asked the creators to give us a handful, and that's how we got to these 4Ms," he says, adding that the 4Ms have been "extremely resonant" among providers.

"If you put in the clinical interventions around them, it saves money, improves care for older adults," he says.

"So, if you reduce exposure to the opioids and benzodiazepines in the medication column, it reduces mobility problems for older adults and it reduces delirium incidents among older adults," he says, "and those things translate into real money and hospital length-of-stays declines."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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