The Age-Friendly Learning Healthcare System: Replicating electronic health record based documentation metrics for 4Ms care

IF 4.3 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2024-12-13 DOI:10.1111/jgs.19311

Jorie M. Butler PhD, Timothy W. Farrell MD, AGSF, Megan Puckett MD, Claude Nanjo MS, Phillip Warner MS, David Shields MS, Mark A. Supiano MD, AGSF, Kensaku Kawamoto MD, PhD, MHS

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引用次数: 0

Abstract

Background

University of Utah Health (UUH) is an academic medical center that achieved “committed to care excellence” in age-friendly care in 2021 and has a long-standing culture of quality improvement central to a learning health system. University of California San Francisco (UCSF) developed electronic health record (EHR) documentation metrics for inpatient assessment of the 4Ms (What Matters, Medication, Mentation, and Mobility) based on the Institute for Healthcare Improvement's recommended care practice for an Age-Friendly Healthcare System. In partnership with UCSF, we replicated the assessment and action EHR metrics with local adaptations for each of the 4Ms at UUH.

Methods

The UCSF team shared 4Ms documentation metrics and Structured Query Language code used to assess 4Ms care at UCSF. At UUH, this code was adapted for a different relational database management system and local clinical context. We assessed 4Ms care, individual M, and composite measures of all 4Ms, for all patients aged 65 and older admitted to UU Hospital between January 1, 2019 and December 31, 2021. We conducted a clinical validation of individual patient cases to confirm accuracy of 4Ms queries.

Results

In the 3-year study period, 16,489 qualifying patients, mean age 74.2, were admitted to UU Hospital in a total of 25,070 admissions with mean length of stay of 6.08 days. We were able to replicate 14 of the 16 EHR metrics of individual 4Ms developed at UCSF and five composite measures. For the composite measure addressing completeness of 4Ms care, 50% of patient encounters had all 4Ms administered during their encounter.

Conclusion

Indicators of the completeness of 4Ms care can be measured using EHR data to validate implementation of the 4Ms at multiple academic medical centers. Key lessons to support future scaled-up assessments include the importance of adapting EHR measures to local activities and involving expert data analysts.

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老年友好型学习医疗保健系统：复制基于电子健康记录的 4Ms 护理文件指标。

背景：犹他大学健康（UUH）是一个学术医疗中心，于2021年在老年人友好型护理中实现了“致力于卓越护理”，并且具有长期的质量改进文化，这是学习卫生系统的核心。加州大学旧金山分校（UCSF）开发了电子健康记录（EHR）文档指标，用于住院患者评估4Ms（重要事项、药物、心理状态和行动能力），该指标基于医疗保健改进研究所推荐的老年人友好型医疗保健系统护理实践。与加州大学旧金山分校合作，我们复制了评估和行动EHR指标，并对UUH的每个4m进行了当地调整。方法：UCSF团队共享了4Ms文档指标和结构化查询语言代码，用于评估UCSF的4Ms护理。在UUH，该代码适用于不同的关系数据库管理系统和当地临床环境。我们评估了2019年1月1日至2021年12月31日期间入住UU医院的所有65岁及以上患者的4Ms护理、个体M和所有4Ms的综合测量。我们对个别病例进行了临床验证，以确认4Ms查询的准确性。结果：在为期3年的研究期间，共有25,070例患者入住UU医院，符合条件的患者16,489例，平均年龄74.2岁，平均住院时间6.08天。我们能够复制UCSF开发的单个4Ms的16个EHR指标中的14个和5个复合指标。对于解决4Ms护理完整性的综合措施，50%的患者就诊期间接受了所有4Ms治疗。结论：利用EHR数据可以衡量4Ms护理的完整性指标，以验证多个学术医疗中心实施了4Ms。支持未来扩大评估的关键经验包括使电子病历措施适应地方活动和让专家数据分析人员参与的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.