Early clinical and quality impacts of the Age-Friendly Health System in a Veterans Affairs skilled nursing facility.

Autor: King SE; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA., Ruopp MD; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Mac CT; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA., O'Malley KA; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA., Meyerson JL; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Lefers L; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA., Bean JF; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA.; Department of PM&R, Harvard Medical School, Boston, Massachusetts, USA.; Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA., Driver JA; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA., Schwartz AW; Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, USA.; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.; Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Jul 15. Date of Electronic Publication: 2024 Jul 15.
DOI: 10.1111/jgs.19083
Abstrakt: Background: Skilled nursing facilities (SNFs) are an ideal setting to implement the Age-Friendly Health System (AFHS) approach, an initiative by the Institute for Healthcare Improvement (IHI) centered on the 4Ms: what matters, mobility, mentation, and medication. AFHS implementation has not been well studied in SNFs.
Methods: A 112-bed VA SNF implemented a facility-wide AFHS initiative including the following: (1) participating in a national IHI Age-Friendly Action Community; (2) establishing an AFHS workgroup centered on the 4Ms; (3) identifying meaningful clinical tools and frameworks for capturing each M; and (4) developing sustainment methods. Clinical (life-sustaining treatment, falls, disruptive behaviors, and medication deprescribing) and quality outcomes (rehospitalization, emergency department utilization, and discharge to the community) in addition to patient satisfaction were compared pre- and post-AFHS implementation (bed days of care [BDOC] 17413) to post-implementation (BDOC 20880).
Results: Clinical outcomes demonstrated improvements in the 4Ms, including: (1) what matters: 14% increase in life-sustaining treatment documentation (82%-96%; p < 0.01); (2) mobility: reduction in fall rate by 34% (8.15 falls/1000 BDOC to 5.41; p < 0.01); (3) mentation: decrease in disruptive behavior reporting system (DBRS) by 62% (5.11 DBRS/1000 BDOC to 1.96; p = 0.04); (4) medications: 53% increase in average potentially inappropriate medications (PIMs) deprescribing (0.38-0.80 interventions/patient; p < 0.01). Quality outcomes improved including rehospitalization (25.6%-17.9%) and emergency department utilization (5.3%-2.8%) within 30 days of admission. Patient satisfaction scores improved from a mean of 77.2 (n = 31, scale 1-100) to 81.3 (n = 42).
Conclusions: Implementation of the AFHS initiative in a SNF was associated with improved clinical and quality outcomes and patient satisfaction. We describe here a sustainable, interprofessional approach to implementing the AFHS in a SNF.
(© 2024 The American Geriatrics Society.)
Databáze: MEDLINE
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