Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
MinuteClinic, CVS Health, Woonsocket, Rhode Island, USA.
J Am Geriatr Soc. 2024 Oct;72(10):3046-3054. doi: 10.1111/jgs.19081. Epub 2024 Jul 17.
The Age-Friendly Health Systems model, encompassing four key elements (4Ms)-What Matters, Medication, Mentation, Mobility-is integral to delivering high-quality care to older adult patients. In May 2020, the MinuteClinic at CVS implemented the 4Ms model in all 1100+ store locations nationwide. To prepare healthcare providers to deliver 4Ms care, educational modules were developed to provide an understanding of the gerontology principles that support the 4Ms model of care. Our goal was to evaluate the effectiveness of these education modules on improving reliable 4Ms delivery during retail clinic visits.
Educational modules were provided to nurse practitioners and physician associates to complete in a self-directed manner. These included an orientation module with scenarios comparing usual care and 4Ms care, 12 monthly grand rounds focusing on 4Ms case studies, and 10 video vignettes on 4Ms integration. We examined the association between number of education modules completed with the average number of Ms delivered per visit (M-Score) using descriptive statistics and a generalized linear mixed-effects model.
Over 70% of 2783 providers completed at least one education module. Rates of 4Ms care delivery were 1.37 (1.36-1.39, p < 0.001) times higher among those that completed an orientation course compared to those that did not. Higher uptake of education exhibited a dose-response relationship with rate ratios between 1.77 (1.74-1.80, p < 0.001) for 1-2 modules beyond orientation, up to 2.94 (2.90-2.99, p < 0.001) for eight or more modules.
The self-directed learning environment (e.g., providers self-select the number and type of courses) reflects real-world variation in engagement. Despite this variation, significant improvements in 4Ms delivery were observed at any level of educational exposure, underscoring the value of prioritizing education time with quality improvement initiatives.
“友好老龄化医疗系统”模式涵盖四个关键要素（4Ms）——重要的事、药物、思维、活动能力，是为老年患者提供高质量护理的关键。2020 年 5 月，CVS 的 MinuteClinic 在全国 1100 多家门店全面实施了 4Ms 模式。为了让医疗服务提供者能够提供 4Ms 护理，我们开发了教育模块，以帮助他们了解支持 4Ms 护理模式的老年医学原则。我们的目标是评估这些教育模块在提高零售诊所就诊时可靠提供 4Ms 服务的效果。
向执业护士和医师助理提供教育模块，供他们自行完成。这些模块包括一个比较常规护理和 4Ms 护理的情景介绍模块、12 个每月一次的重点关注 4Ms 案例研究的大查房模块，以及 10 个关于 4Ms 整合的视频小插曲模块。我们使用描述性统计和广义线性混合效应模型，分析了完成的教育模块数量与每次就诊平均提供的 Ms 数量（M 评分）之间的关联。
超过 70%的 2783 名提供者至少完成了一个教育模块。与未完成该课程的人相比，完成了入门课程的人提供 4Ms 护理的比例高出 1.37 倍（1.36-1.39，p<0.001）。更高的教育接受率与接受率呈剂量反应关系，比率比从 1.77（1.74-1.80，p<0.001）增加到 1-2 个模块，到 2.94（2.90-2.99，p<0.001）增加到 8 个或更多模块。
这种自主学习环境（例如，提供者自行选择课程的数量和类型）反映了现实世界中参与度的差异。尽管存在这种差异，但在任何教育水平上都观察到了 4Ms 提供方面的显著改善，这突显了在质量改进计划中优先考虑教育时间的价值。
