James Kirstyn, Growdon Matthew E, Orkaby Ariela R, Schwartz Andrea Wershof
Department of Geriatric Medicine, Cork University Hospital, T12 DC4A Cork, Ireland.
New England Geriatric Research, Education and Clinical Centers, Division of Geriatrics & Palliative Care, Veteran Affairs Boston Healthcare System, Boston, MA 02130, USA.
Geriatrics (Basel). 2023 Aug 11;8(4):81. doi: 10.3390/geriatrics8040081.
(1) Background: Mobility assessment is a key component of the assessment of an older adult as a part of the Age-Friendly Health System (AFHS) "geriatric 4Ms" framework. Several validated tools for assessing mobility and estimating fall risk in older adults are available. However, they are often under-utilized in daily practice even in specialty geriatric medicine care settings. We aimed to increase formal mobility assessment with brief gait speed measurement in a geriatric medicine outpatient clinic using phased change interventions. (2) Methods: This quality improvement (QI) initiative was conducted in a single outpatient geriatric medicine clinic. All clinic attendees who could complete a gait speed measurement were eligible for inclusion. The outcome measure was the completion of a 4 m gait speed. Several change interventions were implemented on a phased basis using the Model for Improvement methodology during the period from December 2018 to March 2020. Statistical process control charts were used to record gait speed measurements and detect non-random shifts. (3) Results: During this QI initiative, 80 patients were seen, accounting for 142 clinic visits. In response to change interventions, gait speed measurement at clinic visits increased from a median of 25% of visits to 67% by March 2020. (4) Conclusions: Adopting an AFHS care model is an urgent and challenging task to improve the quality of care for older adults. This initiative details how to effectively incorporate a brief, validated assessment of mobility using gait speed measurement into every geriatric medicine outpatient visit and progresses implementation of the AFHS "geriatric 4Ms". Mobility assessment can aid in identifying older adults at increased fall risk.
(1) 背景：作为老年友好型健康系统（AFHS）“老年医学4M”框架的一部分，活动能力评估是老年患者评估的关键组成部分。目前有几种经过验证的工具可用于评估老年人的活动能力和估计跌倒风险。然而，即使在专科老年医学护理环境中，这些工具在日常实践中也常常未得到充分利用。我们旨在通过分阶段的变革干预措施，在老年医学门诊诊所增加使用简短步速测量进行正式的活动能力评估。(2) 方法：这项质量改进（QI）举措在一家门诊老年医学诊所开展。所有能够完成步速测量的诊所就诊者均符合纳入条件。结局指标是完成4米步速测量。在2018年12月至2020年3月期间，使用改进模型方法分阶段实施了多项变革干预措施。使用统计过程控制图记录步速测量数据并检测非随机变化。(3) 结果：在这项QI举措期间，共诊治了80名患者，进行了142次诊所就诊。作为对变革干预措施的回应，到2020年3月，诊所就诊时进行步速测量的比例从中位数的25%增加到了67%。(4) 结论：采用AFHS护理模式是提高老年患者护理质量的一项紧迫且具有挑战性的任务。本举措详细介绍了如何有效地将使用步速测量进行的简短、经过验证的活动能力评估纳入每次老年医学门诊就诊，并推进AFHS“老年医学4M”的实施。活动能力评估有助于识别跌倒风险增加的老年人。
