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Practice Management, Leadership, and Quality Improvement

(Scientific Session) Engaging the Inter-professional Rehabilitation Team to Advance Age-Friendly Care

Saturday, November 18, 2023
10:45 AM – 12:00 PM CT
Location: CC 216

    Primary Author(s)

  • Sunil Sabharwal, MD

    SCI Chief/ Associate Professor of PM&R
    VA Boston HCS/Harvard Medical School
    Boston, Massachusetts

Background and/or Objectives: The 4M framework for Age-Friendly Health Systems (AFHS) is an initiative of the Institute for Healthcare Improvement (IHI) and The John A. Hartford Foundation. Attention to the 4Ms — What Matters, Medication, Mentation, and Mobility — makes complex care of older adults more manageable and identifies core issues that should drive decision-making. We engaged the rehabilitation team to reliably integrate the 4Ms framework in our system of care.

Design: Observational study

Setting: Veterans Affairs (VA) Spinal Cord Injury (SCI) Center

Participants: Inter-professional SCI rehabilitation team

Interventions: Participant engagement in a day-long symposium on the 4M framework, followed by focused meetings to address barriers and unique considerations for integrating the following 4Ms in existing practice: 1) What Matters: Ask older individuals what matters most to align care with each individual’s specific health goals and care preferences. 2) Medication: Use Age-Friendly medication that does not interfere with what matters to the older adult, mobility, or mentation. Avoid, de-prescribe, and dose-adjust high-risk medications when possible. 3) Mentation: Prevent, identify, and manage dementia, depression, and delirium across settings. 4) Mobility: Ensure that older adults with SCI move safely to maintain function and do what matters.

Main Outcome Measures: 1) Familiarity with the 4M framework, 2) Program evaluation, 3) Incorporation of 4Ms in annual evaluations, 4) AFHS recognition by IHI.

Results: Participants rated the symposium very highly. An anonymous survey of participants (n=73) demonstrated a significant increase (12% to 68%) reporting they were very familiar with the 4Ms. Electronic capture of Health Factors for the 4Ms showed a sustained increase and consistent compliance with addressing each 4M during annual evaluations of individuals with SCI, ages 65 and older. As a result of these efforts, the SCI system of care received AFHS recognition by IHI.

Conclusions: When implemented together, the 4Ms can help shift SCI and rehabilitation care systems to optimize care delivery for older adults.