Age-Friendly Health Systems: Improving Care for Older Adults

1. Abington Hospital Jefferson Health Forging Partnerships in the Continuum of Care April 25, 2019 Age-Friendly Health Systems: Improving Care for Older Adults Sarah Maus, LCSW, ACSW Manager, Muller Institute for Senior Health Abington Hospital Jefferson Health

2. Partners

3. Why Age-Friendly Health Systems? • Demography • Complexity • Disproportionate harm

4. What is our aim? • Build a social movement so all care with older adults is age-friendly care: • Guided by an essential set of evidence based practices (4Ms); • Causes no harms; and • Is consistent with What Matters to the older adult and their family. • Our first aim is to reach 20% by December 31, 2020: 1000 hospitals and 1000 primary care practices

5. The 4Ms Framework Age-Friendly care is the reliable implementation of a set of evidence-based geriatric best practice interventions across four core elements, knows as the 4Ms, to all older adults in your system. Fulmer T, Mate KS, Berman A. The Age-Friendly Health System imperative. J Am Geriatr Soc. 2018 Jan;66(1):22-24. doi: 10.1111/jgs.15076.

6. Medications: • Multiple medications increases adverse events & burden • Older adults receive many medications that are potentially harmful & of little benefit • Older adults suffering an adverse drug event have higher rates of morbidity, hospital admission and costs (Field 2005) • 1500 hospitals in HEN 2.0 reduced 15,611 adverse drug events saving $78m across 34 states (HRET 2017)

7. Mentation: • Dementia, delirium, and depression often unrecognized & untreated; associated with increased morbidity, mortality, and costs • Delirium preventable (Inouye) • Depression in ambulatory care doubles cost of care • 16:1 ROI on delirium detection and treatment programs

8. Mobility: • Cost-effective interventions for mobility & fall prevention • Older adults with a serious fall-related injury required an additional $13,316 in hospital costs and had an increased LOS of 6.3 days compared to controls • 30+% reduction in hospital costs among patients who receive care to improve mobility

9. What Matters: • Older adults vary in their health goals & care preferences • Asking & addressing what matters lowers inpatient utilization (54%) while increasing pt satisfaction (AHRQ 2013)

10. Reciprocal/Synergistic Relationships Among 4Ms • Provides feasible framework for implementation and measurement • Addresses older adults’ core health issues • Builds on strong evidence base • Synergistic relationships  simplify and reduce burden on care team while increasing effect • Advances priorities many of the health systems are already focused on

11. Pioneer Health Systems

12. Celebration of Pioneers

13. 4Ms Framework: Hospital

14. 4Ms Framework: Ambulatory

15. · A straightforward and easy - to - use tool, providing the personalized information that healthcare professionals need · designed by the Assissted Living staff to share personalized information about your assisted living residents so that he or she can receive high quality, person - centered care. · A n easy - to - read form · a personalized two - sided sheet that highlights important infor mation that a person would need to provide care in the most comfortable setting for your resident. · help s identify any accommodations that your resident may need · intended to travel with your resident if they require emergency medical services or enter a healthcare facility. It can be stored in a plastic protector or hung on the wall. · should be part of the file containing emergency contact information, MOLST forms and insurance information · By using th e MY STORY tool, residents will be able to share their personal goals and preferences so that they can receive truly person - centered care across the health care continuum. · residents will be able to share their personal goals and preferences so that they can receive truly person - centered care across the health care continuum “ This information is just as important as the emergency transfer information, medications, insurance info etc. We have found MY STORY can be invaluable as 2 residents with dementia presented in the ED with the MY STORY tool and the staff was able to avoid the use of restraints because of the information on this form. ” My Story – Assisted Living Program of Anne Arundel County Department of Aging and Disabilities

16. Anne Arundel Health system

17. Kaiser Permanente

19. Measures for an Age-Friendly Health System Outcome measures • 30-day readmissions (hospital) • Length of stay (hospital) • H/CG – CAHPS (specific measures) • Emergency department utilization (ambulatory) • Advanced measures • Delirium (hospital) • collaboRATE (or similar tool adapted by your system) • Stratification by race and ethnicity Process measure Older adults receiving 4M care (based on your definition and reviewed by IHI for alignment with 4Ms Guide) Total 65+ patients served by the site

20. Definition of an Age-Friendly Health System An Age-Friendly Health System… • Defines the 4Ms for its hospital and/or practice • (e.g. Hospital: How it will screen for delirium every 12 hours; Practice: What tool will it use to screen for depression and how does the screen fit into the AWV flow) • Counts the number of older adults whose care includes the 4Ms (reported by each site) • Shares the information with the Action Community and IHI to be celebrated on IHI.org

22. Join the Movement through an Action Community Reliable 4Ms implementation at the scale of the system Learning & Action Period 6 Learning & Action Period 5 Learning & Action Period 4 Webinar 6 October 2019 Learning & Action Period 3 Webinar 5 September 2019 Learning & Action Period 2 Learning & Action Period 1 Webinar 3 July 2019 Webinar 4 August 2019 Some of the 4Ms sometimes with some older adults  Monthly Webinars and Drop-In Coaching on Measurement and Changes  In-Person June 2019 Webinar 2 May 2019 Webinar 1 April 2019

23. Engage in an Action Community 7 Months Age-Friendly Health System Action Community Leadership Track to Support Scale-Up

24. Session Plan for Action Community • Webinar 1: Assess the 4Ms • Webinar 2: Assess 4Ms with focus on reliability • In Person: Act on the 4Ms with focus on care transitions • Webinar 3: Act on the 4Ms • Webinar 4: Act on the 4Ms with focus on reliability • Webinar 5: Implementation / sustaining the gains • Webinar 6: Scaling up

25. Action Community Resources Technical Requirements for Putting 4Ms into Practice

26. Age-Friendly Health Systems Advisory Group

27. Join Us in the Movement • Visit www.ihi.org/AgeFriendly to access resources, including the 4Ms Framework, Guide to Using the 4Ms in Care of Older Adults, or email AFHS@ihi.org to learn how to join the movement • Join April Age-Friendly Health Systems Action Community to define how to put the 4Ms Framework into practice in your hospital or primary care practice (including FQHCs) • Email AFHS@ihi.org to join • Offer your own Age-Friendly Health Systems Action Community for your state, region, professional association or health system • Email AFHS@ihi.org to obtain the materials and how-to guidance • Tweet about our work at #AgeFriendly