Achievement of age-friendly health systems committed to care excellence designation in a convenient care health care system

Dolansky, MA (通讯作者),Case Western Reserve Univ, Sch Nursing, 9501 Euclid Ave, Cleveland, OH 44106 USA.
2023-2
Objective To describe the implementation of the age-friendly health systems (AFHS) 4Ms Framework, an evidence-based framework to assess and act on What Matters, Medication, Mentation and Mobility to deliver Age-Friendly health care for patients 65 and older, to achieve the Institute for Health care Improvement (IHI) Committed to Care Excellence recognition in a convenient care health system and test two novel implementation strategies. Setting The study was conducted in over 1100 convenient care clinics in 35 states and DC. MinuteClinics are located in community-based retail pharmacies in rural, suburban, and urban areas and staffed with approximately 3300 nurse practitioners and physician associates. Design In Year 1, the project used a quality improvement design, and in Year 2, a quasi-experimental implementation research design to pilot two strategies at the provider level (Virtual Clinic and Plan-Do-Study-Act (PDSA)). Statistical process control charts were used to assess changes in 4Ms documentation over time. Mixed-effects Poisson regression was used to assess the effectiveness of the pilot studies. Data Collection The electronic health record (EHR) was enhanced to capture documentation of the AFHS 4Ms assessments and actions. A learning platform was created to teach and evaluate provider 4Ms competency, and the two data sources were merged into a registry. A formative evaluation was conducted using Tableau and reporting dashboards. Findings After 18 months and the implementation of 20 strategies to improve the uptake of the 4Ms, MinuteClinic achieved the IHI Committed to Care Excellence recognition. A significant increase over time in the reliable delivery of all 4Ms and each M component individually was found. For the research, there were significant improvements in the mean number of Ms delivered per visit (M-Score) in the Virtual Clinic (Incident Rate Ratio [IRR]: 2.47, p = 0.001) and PDSA (IRR: 3.08, p = 0.002) strategy intervention groups when compared to controls. Conclusions Application of quality improvement and implementation methodologies contributed to the success of implementing age-friendly 4Ms evidence-based practice.
HEALTH SERVICES RESEARCH
卷号:58|页码:89-99
ISSN:0017-9124|收录类别:SCIE
语种
英语
来源机构
Case Western Reserve University; Case Western Reserve University; Dartmouth College; Dartmouth College; Dartmouth College; Dartmouth College; Institute for Healthcare Improvement
资助信息
This work is supported by a grant from The John A. Hartford Foundation to the Case Western Reserve University Frances Payne Bolton School of Nursing.
被引频次(WOS)
1
被引频次(其他)
1
180天使用计数
3
2013以来使用计数
3
EISSN
1475-6773
出版年
2023-2
DOI
10.1111/1475-6773.14071
学科领域
循证公共卫生
关键词
age-friendly convenient care evidence-based practice implementation older adult quality improvement reliability
资助机构
John A. Hartford Foundation Case Western Reserve University Frances Payne Bolton School of Nursing
WOS学科分类
Health Care Sciences & Services Health Policy & Services