What matters when it comes to measuring Age-Friendly Health System transformation

doi:10.1111/jgs.18002

. 2022 Oct;70(10):2775-2785.

doi: 10.1111/jgs.18002. Epub 2022 Aug 22.

What matters when it comes to measuring Age-Friendly Health System transformation

Robert E Burke^{1

2

3}, Laura Ellen Ashcraft¹, Kirstin Manges¹, Bruce Kinosian^{1

3

4

5}, Cait M Lamberton⁶, Mary E Bowen^{1

7}, Rebecca T Brown^{1

3

4

5}, Shahrzad Mavandadi⁸, Daniel E Hall^{9

10

11

12}, Rachel M Werner^{1

2

3}

Affiliations

¹ Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
² Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Geriatrics and Extended Care, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
⁶ Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ School of Nursing, University of Delaware, Newark, Delaware, USA.
⁸ Mental Illness Research, Education, and Clinical Center, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
⁹ Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Surgery, School of Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA.
¹¹ Geriatrics Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
¹² Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

PMID: 36053842
DOI: 10.1111/jgs.18002

What matters when it comes to measuring Age-Friendly Health System transformation

Robert E Burke et al. J Am Geriatr Soc. 2022 Oct.

. 2022 Oct;70(10):2775-2785.

doi: 10.1111/jgs.18002. Epub 2022 Aug 22.

Authors

Affiliations

¹ Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
² Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Geriatrics and Extended Care, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
⁶ Wharton School at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁷ School of Nursing, University of Delaware, Newark, Delaware, USA.
⁸ Mental Illness Research, Education, and Clinical Center, Corporal Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
⁹ Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Surgery, School of Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA.
¹¹ Geriatrics Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
¹² Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

PMID: 36053842
DOI: 10.1111/jgs.18002

Abstract

Thousands of health systems are now recognized as "Age-Friendly Health Systems," making this model one of the most widely disseminated - and most promising- models to redesign care delivery for older adults. Sustaining these gains will require demonstrating the impact on care delivery and outcomes of older adults. We propose a new measurement model to more tightly link Age-Friendly Health System transformation to outcomes within each "M" (What Matters, Medications, Mobility, and Mentation). We evaluated measures based on the following characteristics: (1) conceptual responsiveness to changes brought about by practicing "4Ms" care; (2) degree to which they represent outcomes that matter to older adults; and (3) how they can be feasibly, reliably, and validly measured. We offer specific examples of how novel measures are currently being used where available. Finally, we present measures that could capture system-level effects across "M"s. We tie these suggestions together into a conceptual measurement model for AFHS transformation, with the intent to spur discussion, debate, and iterative improvement in measures over time.

Keywords: 4Ms; Age-Friendly; measurement; patient outcomes.

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References

REFERENCES

1. Age-Friendly Health Systems: Measures Guide. Accessed September 2, 2021. http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Docume....
1. Forcino RC, Thygeson M, O'Malley AJ, Meinders MJ, Westert GP, Elwyn G. Measuring patient-reported shared decision-making to promote performance transparency and value-based payment: assessment of collaboRATE's group-level reliability. J Patient Exp. 2020;7(5):742-748. doi:10.1177/2374373519884835
1. Brodney S, Fowler FJ, Barry MJ, Chang Y, Sepucha K. Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales. Med Decis Mak Int J Soc Med Decis Mak. 2019;39(6):673-680. doi:10.1177/0272989X19855951
1. Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688-1697. doi:10.1001/jamainternmed.2019.4235
1. Halpern SD. Goal-concordant care - searching for the holy grail. N Engl J Med. 2019;381(17):1603-1606. doi:10.1056/NEJMp1908153

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The Safer Aging through Geriatrics-Informed Evidence-Based Practices (SAGE) QUERI program is funded by the VA Quality Enhancement Research Initiative (QUERI)

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[1] Age-Friendly Health Systems: Measures Guide. Accessed September 2, 2021. http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Docume....

[2] Age-Friendly Health Systems: Measures Guide. Accessed September 2, 2021. http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Docume....

[3] Forcino RC, Thygeson M, O'Malley AJ, Meinders MJ, Westert GP, Elwyn G. Measuring patient-reported shared decision-making to promote performance transparency and value-based payment: assessment of collaboRATE's group-level reliability. J Patient Exp. 2020;7(5):742-748. doi:10.1177/2374373519884835

[4] Forcino RC, Thygeson M, O'Malley AJ, Meinders MJ, Westert GP, Elwyn G. Measuring patient-reported shared decision-making to promote performance transparency and value-based payment: assessment of collaboRATE's group-level reliability. J Patient Exp. 2020;7(5):742-748. doi:10.1177/2374373519884835

[5] Brodney S, Fowler FJ, Barry MJ, Chang Y, Sepucha K. Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales. Med Decis Mak Int J Soc Med Decis Mak. 2019;39(6):673-680. doi:10.1177/0272989X19855951

[6] Brodney S, Fowler FJ, Barry MJ, Chang Y, Sepucha K. Comparison of three measures of shared decision making: SDM Process_4, CollaboRATE, and SURE scales. Med Decis Mak Int J Soc Med Decis Mak. 2019;39(6):673-680. doi:10.1177/0272989X19855951

[7] Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688-1697. doi:10.1001/jamainternmed.2019.4235

[8] Tinetti ME, Naik AD, Dindo L, et al. Association of patient priorities-aligned decision-making with patient outcomes and ambulatory health care burden among older adults with multiple chronic conditions: a nonrandomized clinical trial. JAMA Intern Med. 2019;179(12):1688-1697. doi:10.1001/jamainternmed.2019.4235

[9] Halpern SD. Goal-concordant care - searching for the holy grail. N Engl J Med. 2019;381(17):1603-1606. doi:10.1056/NEJMp1908153

[10] Halpern SD. Goal-concordant care - searching for the holy grail. N Engl J Med. 2019;381(17):1603-1606. doi:10.1056/NEJMp1908153

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What matters when it comes to measuring Age-Friendly Health System transformation

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What matters when it comes to measuring Age-Friendly Health System transformation

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