Kalsy Megha, Church Kimberly, Bowman Ella, Mirk Anna, Olunuga Deslyn, Edes Thomas
Veterans Affairs Northeast Ohio Healthcare System, Cleveland.
Veterans Health Administration, Geriatrics and Extended Care, Washington, DC.
Fed Pract. 2023 Oct;40(10):344-348b. doi: 10.12788/fp.0420. Epub 2023 Oct 12.
The need for a health care workforce with expanded skills in the care of older adults is increasingly evident as the US population ages. The evidence-based Age-Friendly Health Systems (AFHS) framework establishes a structure to reliably assess and deliver effective care of older adults with multiple chronic conditions: what matters, medication, mentation, and mobility (4Ms). Half of veterans receiving Veterans Health Administration (VHA) care are aged ≥ 65 years, driving its transformation into the largest AFHS in the US. In this article, we offer lessons on the challenges to AFHS delivery and suggest opportunities to sustaining age-friendly care.
Within 3 months of implementation, 85% to 100% of patients received 4M care in all care settings at our VA facilities. Key lessons learned include the importance of identifying, preparing, and supporting a champion to lead this effort; garnering facility and system leadership support at the outset; and integration with the electronic health record (EHR) for reliable and efficient data capture, reporting, and feedback. Although the goal is to establish AFHS in all care settings, we believe that initially including a geriatrics-focused care setting helped early adoption of 4Ms care in the sites described here.
Early adopters at 2 VHA health care systems demonstrated successful AFHS implementation spanning different VHA facilities and care settings. Successful growth and sustainability may require leveraging the EHR to reduce documentation burden, increase standardization in care, and automate feedback, tracking, and reporting. A coordinated effort is underway to integrate AFHS into VHA documentation, performance evaluation, and metrics in both the legacy and new Cerner EHRs.
随着美国人口老龄化，对具备照顾老年人扩展技能的医疗保健劳动力的需求日益明显。基于证据的老年友好型医疗系统（AFHS）框架建立了一种结构，以可靠地评估和提供对患有多种慢性病的老年人的有效护理：重要事项、药物治疗、心理状态和行动能力（4M）。接受退伍军人健康管理局（VHA）护理的退伍军人中有一半年龄在65岁及以上，这推动了VHA向美国最大的AFHS转变。在本文中，我们提供了关于AFHS实施挑战的经验教训，并提出了维持老年友好型护理的机会。
在实施后的3个月内，我们VA设施的所有护理环境中，85%至100%的患者接受了4M护理。获得的关键经验教训包括确定、培养和支持一位领导者来引领这项工作的重要性；从一开始就获得机构和系统领导层的支持；以及与电子健康记录（EHR）集成，以进行可靠且高效的数据采集、报告和反馈。尽管目标是在所有护理环境中建立AFHS，但我们认为，最初纳入以老年医学为重点的护理环境有助于在此处所述的场所早期采用4M护理。
两个VHA医疗保健系统的早期采用者展示了在不同VHA设施和护理环境中成功实施AFHS。成功的发展和可持续性可能需要利用EHR来减轻文档负担、提高护理标准化程度以及自动进行反馈、跟踪和报告。正在进行协调努力，将AFHS集成到VHA在传统和新的Cerner EHR中的文档、绩效评估和指标中。
