Creation of a Whole Health Age-Friendly Template and Dashboard Facilitates Implementation of 4Ms into Primary Care

The Veterans Administration has joined the Age-Friendly Health Systems (AFHS) movement as part of its Whole Health initiative to provide safe, high-quality geriatric care using a set of evidence-based practices known as the “4Ms”—What Matters, Medication, Mentation, and Mobility—to provide care across all care settings. Two healthcare centers utilized an automated review of 4Ms care. For non-templated notes in the TVHS GeriPACT clinic over a 30-day period, all the 4Ms health factors (HFs) were addressed in only 1% of patients, and 16% had three HFs, 37% had two HFs, and 71% had one HF addressed. During the pilot of a new templated note and associated dashboard at the RICVAMC, GeriPACT and Home-Based Primary Care (HBPC) addressed all the age-friendly health factors in 41% of patients, while 24% had three health factors, 10% had two health factors, and 13% had one health factor addressed, and 10% were indeterminate by manual review. For both facilities, What Matters Most had the lowest prevalence, representing the most difficult individual health factor to address. The use of a templated note improves the reliable delivery of age-friendly care compared to non-templated notes and facilitates the dashboard display of practice- and provider-specific age-friendly encounter data, which may provide useful QI information to clinicians and health systems.