Welch Sarah A, Archer Kristin R, Hymel Alicia M, Pennings Jacquelyn S, Schwartz Andrea Wershof, Kang Christy, Qian Edward T, Duggan Maria C, Roumie Christianne L
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Geriatric Research Education and Clinical Center (GRECC), Department of Veteran Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
J Am Geriatr Soc. 2025 Jan;73(1):172-181. doi: 10.1111/jgs.19205. Epub 2024 Oct 7.
For the thousands of health systems recognized as Age-Friendly, considerable progress has been made to integrate 4Ms into clinical care. This study evaluated associations between 4Ms documentation and patient characteristics in an inpatient setting.
In this prospective cohort, hospitalizations included were from patients in an Acute Care for Elders (ACE) unit where the 4Ms were adopted and implemented. Each M (What Matters, Medication, Mentation, and Mobility) was stratified into three categories (not documented, partly documented, and fully documented) reflecting "assessment" and "action" clinical care processes. Electronic health records were reviewed for patient and hospitalization characteristics. Descriptive statistics evaluated these characteristics across categories of each M.
There were 620 hospital encounters (573 patients) included in the cohort. Patients had a median age of 80 years [IQR 76, 86] and 85% were White. Of all 4Ms, What Matters had the lowest documentation with 413 (67%) of encounters falling into the not documented group. Medication had the highest documentation with 453 (73%) of encounters in the fully documented group. Significant differences in documentation were associated with age and partly versus fully documented Mobility (80 [76, 86] and 82 [77, 88] (p = 0.019)). Hospital length of stay was differentially associated with documentation of all 4M categories. Initial mobility scores were associated with not versus partly documented Medication (6 [2, 7] and 2 [2, 6] (p = 0.041)).
We developed a structured way to categorize "assessment" and "action" 4Ms care processes reflective of three documentation categories in the hospital (not, partly, and fully) and identified important patient and hospital characteristics associated with each. These results offer opportunities for future improvement efforts and insight to which characteristics may be important to measure with wider 4Ms adoption and uptake.
对于数千个被认定为老年友好型的医疗系统而言，在将4M原则融入临床护理方面已取得了相当大的进展。本研究评估了住院环境中4M原则记录与患者特征之间的关联。
在这个前瞻性队列研究中，纳入的住院病例来自采用并实施了4M原则的老年急性护理（ACE）单元的患者。每个M（重要事项、药物治疗、认知功能、活动能力）被分为三类（未记录、部分记录、完整记录），以反映“评估”和“行动”的临床护理过程。对电子健康记录进行审查，以获取患者和住院病例的特征。描述性统计分析评估了每个M类别中的这些特征。
该队列纳入了620次住院病例（573名患者）。患者的中位年龄为80岁[四分位间距76, 86]，85%为白人。在所有4M原则中，重要事项的记录率最低，413次（67%）住院病例属于未记录组。药物治疗的记录率最高，453次（73%）住院病例属于完整记录组。记录的显著差异与年龄以及部分记录与完整记录的活动能力相关（80[76, 86]和82[77, 88]（p = 0.019））。住院时间与所有4M类别的记录存在差异关联。初始活动能力评分与未记录与部分记录的药物治疗相关（6[2, 7]和2[2, 6]（p = 0.041））。
我们开发了一种结构化方法，将反映医院中三类记录（未记录、部分记录、完整记录）的“评估”和“行动”4M原则护理过程进行分类，并确定了与之相关的重要患者和医院特征。这些结果为未来的改进工作提供了机会，并深入了解了在更广泛采用和应用4M原则时哪些特征可能对测量很重要。
