Evaluation of an Age-Friendly Health System: 4Ms Assessments and Outcomes in Hospitalized Older Adults

TL;DR

This study evaluates how using a framework called 4Ms in hospitals affects outcomes for older adults, finding that those who received all 4Ms had fewer emergency visits and possibly better readmission rates.

Contribution

The study provides preliminary evidence on the impact of the 4Ms framework on outcomes in hospitalized older adults.

Findings

Patients who received all 4Ms had fewer 30-day ED visits and a trend toward lower readmissions.

Those receiving 4Ms were older and had lower mobility scores.

Higher mortality was observed in the 4Ms group, possibly due to greater illness burden.

Abstract

The Institute for Healthcare Improvement developed the 4Ms framework (What Matters Most/Medication/Mentation/Mobility) to facilitate Age-Friendly Health Systems (AFHS). Each M has evidence-based screening tools leading to improved outcomes among older adults. We report screening 4Ms vs. 1-3Ms outcomes for hospitalized adults aged ≥65 across hospitals in a large healthcare system. Demographics and clinical data abstracted manually from EMR and from 4Ms AFHS dashboard.

Patients ≥65y/o admitted July-September 2024 to eight hospitals committed to care excellence. Outcomes: Length of stay (LOS), 30-day readmission, 30-day ED visits, mortality. Of 3,103 older adult admissions, 298 (9.6%) received all 4Ms and 2,805 received 1-3Ms. Median age: for 4Ms, 84 (IQR:76-90) and for 1-3Ms, 77 (IQR:71-84). Primary language was English for both. Median LOS: for 4Ms, 9 days (IQR:6-15) and for 1-3Ms, 9 days (IQR:5-16). Those receiving 4Ms had a lower AMPAC mobility score (13 vs 18, p < 0.001) fewer 30-day ED visits (16% vs. 22%, p = 0.02), higher mortality (11% vs. 5.3% p < 0.001), and trend towards lower 30-day readmissions (13% vs. 16%, p = 0.2). In conclusion, a small proportion of hospitalized older adults were screened for all 4Ms. Those with 4Ms were older with lower mobility. They had fewer post-discharge ED visits and a trend towards lower readmissions which may become significant with accrual of more events. Higher mortality may reflect age, greater illness burden. This preliminary assessment provides evidence for 4Ms care as a quality framework associated with key patient outcomes.