Reynolds Section of Geriatrics and Palliative Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma, USA.
J Am Geriatr Soc. 2024 Aug;72 Suppl 3:S23-S35. doi: 10.1111/jgs.18848. Epub 2024 Mar 15.
Age-friendly care, addressing what matters most, medications, mentation, and mobility, is a successful model for improving older adult care. We describe the initial outcomes of age-friendly care implementation in five primary care clinics in an academic health system.
In partnership with a regional quality improvement (QI) organization, we used practice facilitation to implement age-friendly care from July 2020 to June 2023. Clinic workflows and electronic health record (EHR) templates were modified to capture six QI measures for patients ≥65 years: Documenting what matters most to patients Advance care planning (ACP) Annual cognitive screening Caregiver referral to dementia community resources Fall-risk screening Co-prescription of opioid and sedative-hypnotic drugs Providers were alerted if patients had positive screens and given support tools for clinical decision-making. QI measures from January-June 2023 were compared to the year prior to implementation. Providers and staff were interviewed about implementation barriers and facilitators.
All six measures improved in Geriatrics and and other clinics showed improvement in ACP and cognitive screening. All clinics had high fall-risk screening rates (≥85%). The least improved measure was co-prescription of opioids and sedative-hypnotics with co-prescription rates ranging from 7% to 39%. Implementation hinged on leadership prioritization, practice facilitator guidance, clinical team buy-in, EHR functionality, and clinical performance review. Three clinics received Age-Friendly Health System recognition.
A QI approach using practice facilitation and EHR templates improved some but not all age-friendly care measures. Future interventions will focus on training in high-risk medication tapering and elicitation of health goals.
以关怀老年人为重点，关注最重要的事情，包括药物治疗、心理状态和行动能力，是改善老年人医疗服务的成功模式。我们描述了在学术医疗系统的五个初级保健诊所中实施以关怀老年人为重点的初始结果。
我们与一个地区性质量改进组织合作，从 2020 年 7 月至 2023 年 6 月，利用实践促进的方式实施以关怀老年人为重点的措施。修改了诊所的工作流程和电子健康记录 (EHR) 模板，以捕捉针对 65 岁以上患者的六项质量改进措施：记录患者最重要的事情、预先护理计划 (ACP)、年度认知筛查、向痴呆症社区资源转介照顾者、跌倒风险筛查、阿片类药物和镇静催眠药物的共同处方。如果患者的筛查结果为阳性，将向提供者发出警报，并提供临床决策支持工具。将 2023 年 1 月至 6 月的质量改进措施与实施前一年进行比较。对提供者和工作人员进行了有关实施障碍和促进因素的访谈。
所有六项措施在老年医学科和其他科室都有所改善，ACP 和认知筛查有所改善。所有科室的跌倒风险筛查率都很高（≥85%）。改善最小的措施是阿片类药物和镇静催眠药物的共同处方，共同处方率在 7%至 39%之间。实施取决于领导层的优先事项、实践促进者的指导、临床团队的认同、EHR 的功能和临床绩效审查。三个科室获得了以关怀老年人为重点的健康系统认可。
采用实践促进和 EHR 模板的质量改进方法改善了一些但不是所有的以关怀老年人为重点的护理措施。未来的干预措施将侧重于高危药物逐渐减少的培训和健康目标的制定。
