Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut.
Yale School of Medicine, Center for Outcomes Research and Evaluation, New Haven, Connecticut.
West J Emerg Med. 2022 Jul 1;23(4):579-588. doi: 10.5811/westjem.2022.4.56115.
The "4Ms" model - What Matters, Medication, Mentation, and Mobility - is increasingly gaining attention in age-friendly health systems, yet a feasible approach to identifying what matters to older adults in the emergency department (ED) is lacking. Adapting the "What Matters" questions to the ED setting, we sought to describe the concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians.
We conducted 46 dyadic semi-structured interviews of cognitively intact older adults and their treating clinicians. We used the "What Matters" conversation guide to explore patients' 1) concerns and 2) desired outcomes. We then asked analogous questions to each patient's treating clinician regarding the patient's priorities. Interviews were professionally transcribed and coded using an inductive approach of thematic analysis to identify emergent themes.
Interviews with older adults lasted a mean of three minutes, with a range of 1-8 minutes. Regarding patients' concerns, five themes emerged from older adults: 1) concern through a family member or outpatient clinician recommendation; 2) no concern, with a high degree of trust in the healthcare system; 3) concerns regarding symptom cause identification; 4) concerns regarding symptom resolution; and 5) concerns regarding preservation of their current status. Regarding desired outcomes, five priority themes emerged among older adults: 1) obtaining a diagnosis; 2) returning to their home environment; 3) reducing or resolving symptoms; 4) maintaining self-care and independence; and 5) gaining reassurance. Responding to what they believed mattered most to older adult patients, ED clinicians believed that older adults were concerned primarily about symptom cause identification and resolution and primarily desired a return to the home environment and symptom reduction.
This work identifies concerns and desired outcomes of both older adult patients seeking ED care and their treating clinicians as well as the feasibility of incorporating the "What Matters" questions within ED clinical practice.
“4Ms”模型——重要的事情、药物、思维和活动能力——在老年友善型卫生系统中越来越受到关注，但缺乏一种可行的方法来确定急诊科（ED）老年人关心的问题。我们通过调整“重要的事情”问题来适应 ED 环境，旨在描述寻求 ED 护理的老年患者及其治疗临床医生的关注点和期望结果。
我们对认知功能正常的老年患者及其治疗临床医生进行了 46 次双人半结构化访谈。我们使用“重要的事情”对话指南来探讨患者的 1）关注点和 2）期望结果。然后，我们向每位患者的治疗临床医生询问了关于患者优先级的类似问题。访谈由专业人员转录并进行了主题分析的归纳方法编码，以确定出现的主题。
对老年人的访谈平均持续三分钟，范围为 1-8 分钟。关于患者的关注点，老年人出现了五个主题：1）通过家庭成员或门诊临床医生的推荐而产生的担忧；2）没有担忧，对医疗保健系统高度信任；3）对症状原因识别的担忧；4）对症状缓解的担忧；5）对维持现状的担忧。关于期望的结果，老年人中出现了五个优先主题：1）获得诊断；2）回到他们的家庭环境；3）减轻或缓解症状；4）保持自我护理和独立性；5）获得安心。回应他们认为对老年患者最重要的事情，ED 临床医生认为，老年患者主要关注症状的原因识别和解决，主要期望返回家庭环境并减轻症状。
这项工作确定了寻求 ED 护理的老年患者及其治疗临床医生的关注点和期望结果，以及在 ED 临床实践中纳入“重要的事情”问题的可行性。
