CLEVELAND—The Frances Payne Bolton School of Nursing at Case Western Reserve University is charting a path toward a more age-friendly health care experience for older adults.
In late 2018, researchers at the school of nursing, working with MinuteClinic—the retail medical clinic of CVS Health—in collaboration with the Institute for Healthcare Improvement (IHI), received a one-year, $945,000 planning grant from The John A. Hartford Foundation (JAHF) as part of its Age-Friendly Health Systems initiative.
Age-Friendly Health Systems is an initiative of The JAHF and IHI, in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).
Two years ago, Case Western Reserve and CVS Health began mapping out a plan to enhance care for the increasing number of older adults treated by nurse practitioners and physician assistants.
Now, they’re putting that plan into action at 1,100 MinuteClinic locations across the United States, the nation’s largest retail ambulatory care network.
Funded by a new three-year, $2.44 million JAHF grant, researchers and planners at the nursing school will work with MinuteClinic to integrate into a clinic visit the “4Ms” framework (What Matters, Medication, Mentation and Mobility)—the Age-Friendly initiative’s cornerstone approach designed to be equally effective in acute care and ambulatory settings.
The team, with assistance from IHI, will work with providers at MinuteClinic to incorporate the age-friendly concepts into their day-to-day care for older adults and track their implementation at all retail locations.
“What this means for the consumer, the older adult who is coming to the clinic for basic health care, is that he or she will be cared for in a way that honors the specific needs of that population,” said Mary Dolansky, PhD, associate professor and director of the QSEN (Quality Safety Education for Nurses) Institute at the nursing school, who is leading the project. “What it means for us is that we will be coaching more than 3,000 providers to focus on caring for an older population and measuring competence in that care.”
Many of the MinuteClinics’ providers are nurse practitioners, she said, giving the Case Western Reserve nursing team particular insight into that work force.
“By applying the 4Ms, MinuteClinic providers will be able to positively impact many of our patients, in a comfortable and familiar setting,” said Angela Patterson, DNP, chief nurse practitioner officer, MinuteClinic, and vice president, CVS Health. “Through collaboration with The John A. Hartford Foundation, the Frances Payne Bolton School of Nursing, and the Institute for Healthcare Improvement, MinuteClinic will be the largest retail clinic network in the U.S. to adopt the 4Ms system-wide.”
Case Western Reserve researchers will also observe how providers are integrating age-friendly practices into their daily work, Dolansky said.
What is ‘Age-Friendly?’
Among the most valuable components of those practices is “spending time finding out what matters to the patient—not just what brought them to the clinic that day, such as a sore throat or cough, but also what really matters most in their life,” said Robin Hughes, an adult gerontology primary care nurse practitioner at the Frances Payne Bolton School of Nursing school and project manager for the grant.
Hughes said providers would use the Age-Friendly 4Ms Framework, along with an American Geriatrics Society standard known as the Beers Criteria®, to guide them. For example, they would use the criteria to identify and address high-risk medications that may not be safe for older adults.
“Some of these medications can cause confusion, sleepiness and even an unsteady gait, which could then lead to a fall and affect their daily routine and what matters to them,” Hughes said. “Assessing the 4Ms as a set and acting on findings is part of what it means to provide age-friendly care.”
Equipping health care providers—specifically those at retail clinics such as MinuteClinic—to better serve older adults is an industry trend. Retail clinics long served primarily younger clients who do not have a primary care provider, offering care for routine issues such as vaccinations, physicals and mild illnesses. But they began to see the average age of their customers rising over the years.
“More than 10,000 people turn 65 every day in this country, which is why we need age-friendly care in MinuteClinics and every care setting,” said Terry Fulmer, PhD, president of The John A. Hartford Foundation. “The outstanding work of the Frances Payne Bolton School of Nursing in partnership with CVS Health is a game-changer for older adults across the country who will get the care they need and deserve.”
Dolansky said the health care industry has long focused on the physical health of older patients, but now we know that considering physical and mental/emotional health is needed in order to provide age-friendly care by aligning these in the treatment plan with what matters most.
“We don’t routinely talk about things like cognitive decline and depression and we don’t provide enough guidance for our providers to focus on age-friendly practices for older adults,” she said. “We have to address these things. We cannot ignore them.”
Dolansky said that’s what makes this project with MinuteClinic so significant: “It’s starting here,” she said, “but it’s a movement that we believe will spread.”
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About Case Western Reserve University
Case Western Reserve University is one of the country’s leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,100 undergraduate and 6,200 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.
About The John A. Hartford Foundation
The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. For more than three decades, the organization has been the leader in building a field of experts in aging and testing and replicating innovative approaches to care. The Foundation has three priority areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care. Working with its grantees, the Foundation strives to change the status quo and create a society where older adults can continue their vital contributions. For more information, visit johnahartford.org and follow @johnahartford.
About Institute for Healthcare Improvement (IHI)
The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization based in Boston, Massachusetts, USA. For more than 25 years, IHI has used improvement science to advance and sustain better outcomes in health and health systems across the world. IHI brings awareness of safety and quality to millions, catalyzes learning and the systematic improvement of care, develops solutions to previously intractable challenges, and mobilizes health systems, communities, regions, and nations to reduce harm and deaths. IHI collaborates with a growing community to spark bold, inventive ways to improve the health of individuals and populations. IHI generates optimism, harvests fresh ideas, and supports anyone, anywhere who wants to profoundly change health and health care for the better. Learn more at ihi.org.
About MinuteClinic
MinuteClinic is the retail medical clinic of CVS Health (NYSE: CVS), the largest pharmacy health care provider in the United States. MinuteClinic launched the first retail medical clinics in the United States in 2000 and is the largest provider of retail clinics with more than 1,100 locations in 33 states and the District of Columbia. By creating a health care delivery model that responds to patient demand, MinuteClinic makes access to high-quality medical treatment easier for more Americans. Nationally, the company has provided care through more than 42 million patient visits, with a 95 percent customer satisfaction rating. MinuteClinic is the only retail health care provider to receive four consecutive accreditations from The Joint Commission, the national evaluation and certifying agency for nearly 21,000 health care organizations and programs in the United States. For more information, visit minuteclinic.com
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