Leveraging the EHR to Promote Age-Friendly Care in Hospitals (LEAF) - Project Summary: The ultimate goal of this study is to improve hospital care for older adults. Maintaining cognition and physical function are critically important goals to most older patients, and yet our current hospital care results in 40% losing physical function and 18-50% suffering from delirium. The 4Ms Framework (What Matters Most, Mentation, Medications, and Mobility) is an evidence-based framework of care which reduces healthcare costs, hospital-acquired delirium, and functional decline. However, this framework and similar national geriatric quality improvement (QI) programs for hospitalized older adults (Geriatric Emergency Department Accreditation, Nurses Improving Care for Healthsystem Elders (NICHE), Geriatric Fracture Society and Geriatric Surgery Verification) have seen limited adoption in hospitals. One obstacle to dissemination is the lack of standardized integration of the 4Ms into electronic health records (EHRs) in a way that is easily used by staff for clinical decision making. Leveraging the EHR to Promote Age-Friendly Care in Hospitals (LEAF) will bring together interdisciplinary stakeholders from these five national geriatric QI programs and front-line hospital staff to design an EHR navigator that collates 4Ms information and is easily visible to all healthcare team members. The “4Ms Navigator” will use behind the scenes “bookmarks” to actively collate geriatric assessments and information in real time in one place for clinical use. This will prevent information loss between healthcare encounters and promote communication during hospitalizations. (Aim 1) We will evaluate current best practices, perform workflow analyses, and prioritize elements for the navigator design using nominal group theory techniques. The Consolidated Framework for Implementation Research (CFIR) will be used to guide implementation at the pilot health system. The pilot data will be used to refine the 4Ms Navigator and then (Aim 2) implement it at 4 other healthsystems with diverse geriatric QI programs. We will track the implementation support needed to achieve adoption across the hospitals (Aim 2a). Aims 2b and 2c will track the impact on care quality (hospital length of stay, 30-day rehospitalizations, and emergency department admission rates for older patients). In addition to these current quality measures, the 4Ms Navigator design stakeholder group will also discuss and design novel electronic clinical quality measures (eCQMs) for hospitalized older adults that consider their unique patient centered goals, such as maintaining cognition and physical function. Finally, we will test the reliability and validity of the 4Ms Navigator for eCQM abstraction. Conclusion: This project will engage stakeholders throughout the building and testing of essential clinical EHR infrastructure and improve the abstraction of 4Ms information for quality assessment. This study will gather data on adoption, adaption, implementation needs, and clinical outcomes to prepare for national dissemination. Developing EHR infrastructure that meets the criteria of multiple national geriatric QI programs and promotes adoption of high quality clinical care is novel and will spur better care for millions of older adults.
