The Center for Healthy Aging applied to age-friendly health system (AFHS) in 2019, with the intention of advancing the level of geriatric care in our clinic through the adoption of 4Ms of AFHS. Prior to applying to participate in AFHS, we assumed that our geriatric care was complete. The clinic was providing three of the 4Ms: mentation with the PHQ9 and dementia assessments, mobility assessments with the get-up-and-go test, and medication review with every appointment. The last M was the what matters most (WMM) question. The 4Ms framework was developed using evidence-based intervention with 2 important drivers, assessment and action.
In order to become recognized by AFHS , the clinic began a quality improvement process over several months. Initially, we surveyed our team to determine which what matters most question (WMM) we would ask our patients. The Allscripts team provides a monthly report of the number of patients asked what matters most including the actual answers and patient demographics. Regular communications and progress reports were submitted to AFHS for review. Most patients were pleased and surprised when asked what matter most to them. The answers became a permanent part of their chart. The clinic achieved recognition after 3 months of PDSA.
As providers, we can make assumptions about what matters most to our patients. Our assumptions can influence care. We were assessing and acting on the individual WMM responses but still had preconceived assumptions about what mattered most. Four months of patient WMM responses were compiled and ranked in order of frequency. Providers then ranked the list of top patient responses according to their assumptions about our patients.
The top themes for patients were safety, independence, and family, while the providers and staff top themes were weight, safety, and pain. Though dementia or memory loss was never mentioned by patients, it was a major assumption of importance by the providers and staff. This project provided more insight into what matters most to our patients and helped to guide the care provided by advance practice nurses and physicians to our patients.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
DNP, APRN, GNP-BC,
McGovern Medical School
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