Tzeng Huey-Ming, Kuo Yong-Fang, Pappadis Monique R, Hennessy Elizabeth A, Marquez-Bhojani Maribel M, David Samuel V, Harrell Demetress, Raji Mukaila A
The University of Texas Medical Branch, Galveston, TX, USA.
Hospice in the Pines, Lufkin, TX, USA.
Sage Open Aging. 2025 Jul 23;11:30495334251358620. doi: 10.1177/30495334251358620. eCollection 2025 Jan-Dec.
Drawing on the Institute of Healthcare Improvement (IHI)'s 4Ms framework of an Age-Friendly Health System in primary care to incorporate "What Matters," mentation, mobility, and medication, this qualitative/interview pilot study listened to "What Matters" most to community-dwelling Medicare beneficiaries with dementia and family caregivers in the context of Annual Wellness Visit (AWV). We then mapped identified "What Matters" themes (health goals and worries) to IHI-4Ms. Twenty-four caregivers and two patients participated in a one-time phone/Zoom interview. We observed three overarching goal themes (physical/mental health maintenance, cognitive maintenance, and independence) and six overarching worry themes (cognitive decline, behavioral changes, health decline leading to loss of independence, mobility issues, dehydration, and caregivers' financial responsibility). The identified goals and worries were mapped to at least one of IHI-4Ms components, indicating the potential for addressing these through AWVs. Our study is the first to understand "What Matters" to Medicare beneficiaries with MCI/ADRD in the context of AWVs and to map the identified health goals and worries to IHI-4Ms. The valuable lessons learned in this pilot study underscore the potential need for practical health policy considerations to support dementia-friendly AWVs so that "What Matters" to patients with MCI/ADRD and caregivers can be heard/discussed during AWVs.
借鉴医疗保健改善研究所（IHI）在初级保健中构建的适老化健康系统的4Ms框架，该框架包含“重要事项”、认知、活动能力和药物治疗，这项定性/访谈试点研究在年度健康检查（AWV）背景下，聆听了患有痴呆症的社区医保受益人和家庭护理人员认为“最重要的事项”。然后，我们将确定的“重要事项”主题（健康目标和担忧）与IHI的4Ms框架进行了映射。24名护理人员和2名患者参与了一次性的电话/Zoom访谈。我们观察到三个总体目标主题（身体/心理健康维持、认知维持和独立性）和六个总体担忧主题（认知能力下降、行为改变、健康状况下降导致失去独立性、活动能力问题、脱水以及护理人员的经济责任）。所确定的目标和担忧被映射到了IHI-4Ms框架的至少一个组成部分，这表明通过年度健康检查来解决这些问题具有潜力。我们的研究首次在年度健康检查背景下，了解患有轻度认知障碍/晚期痴呆相关疾病（MCI/ADRD）的医保受益人的“重要事项”，并将所确定的健康目标和担忧与IHI-4Ms框架进行映射。在这项试点研究中汲取的宝贵经验凸显了在制定实际健康政策时，可能需要考虑支持对痴呆症友好的年度健康检查，以便在年度健康检查期间能够倾听/讨论对患有MCI/ADRD的患者及其护理人员而言“重要的事项”。
