Butler Jorie M, Farrell Timothy W, Puckett Megan, Nanjo Claude, Warner Phillip, Shields David, Supiano Mark A, Kawamoto Kensaku
Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
J Am Geriatr Soc. 2025 Mar;73(3):707-716. doi: 10.1111/jgs.19311. Epub 2024 Dec 13.
University of Utah Health (UUH) is an academic medical center that achieved "committed to care excellence" in age-friendly care in 2021 and has a long-standing culture of quality improvement central to a learning health system. University of California San Francisco (UCSF) developed electronic health record (EHR) documentation metrics for inpatient assessment of the 4Ms (What Matters, Medication, Mentation, and Mobility) based on the Institute for Healthcare Improvement's recommended care practice for an Age-Friendly Healthcare System. In partnership with UCSF, we replicated the assessment and action EHR metrics with local adaptations for each of the 4Ms at UUH.
The UCSF team shared 4Ms documentation metrics and Structured Query Language code used to assess 4Ms care at UCSF. At UUH, this code was adapted for a different relational database management system and local clinical context. We assessed 4Ms care, individual M, and composite measures of all 4Ms, for all patients aged 65 and older admitted to UU Hospital between January 1, 2019 and December 31, 2021. We conducted a clinical validation of individual patient cases to confirm accuracy of 4Ms queries.
In the 3-year study period, 16,489 qualifying patients, mean age 74.2, were admitted to UU Hospital in a total of 25,070 admissions with mean length of stay of 6.08 days. We were able to replicate 14 of the 16 EHR metrics of individual 4Ms developed at UCSF and five composite measures. For the composite measure addressing completeness of 4Ms care, 50% of patient encounters had all 4Ms administered during their encounter.
Indicators of the completeness of 4Ms care can be measured using EHR data to validate implementation of the 4Ms at multiple academic medical centers. Key lessons to support future scaled-up assessments include the importance of adapting EHR measures to local activities and involving expert data analysts.
犹他大学健康中心（UUH）是一家学术医疗中心，于2021年在老年友好型护理方面实现了“致力于卓越护理”，并且拥有一种长期的质量改进文化，这是学习型健康系统的核心。加利福尼亚大学旧金山分校（UCSF）根据医疗保健改进研究所针对老年友好型医疗系统推荐的护理实践，开发了用于住院患者4Ms（重要事项、药物治疗、精神状态和活动能力）评估的电子健康记录（EHR）文档指标。与UCSF合作，我们在UUH对每个4M进行了本地化调整，复制了评估和行动EHR指标。
UCSF团队分享了用于评估UCSF的4Ms护理的4Ms文档指标和结构化查询语言代码。在UUH，此代码针对不同的关系数据库管理系统和当地临床情况进行了调整。我们评估了2019年1月1日至2021年12月31日期间入住UU医院的所有65岁及以上患者的4Ms护理、单个M以及所有4Ms的综合指标。我们对个体患者病例进行了临床验证，以确认4Ms查询的准确性。
在3年的研究期内，共有16489名符合条件的患者（平均年龄74.2岁）入住UU医院，共25070次住院，平均住院时长为6.08天。我们能够复制UCSF开发的16个单个4M的EHR指标中的14个以及5个综合指标。对于涉及4Ms护理完整性的综合指标，50%的患者就诊期间接受了所有4Ms。
可以使用EHR数据来衡量4Ms护理完整性的指标，以验证多个学术医疗中心4Ms的实施情况。支持未来扩大评估规模的关键经验教训包括使EHR措施适应当地活动以及让专家数据分析师参与的重要性。
