What Matters: Age-Friendly Health System Work Expands
Andrew Schwartzman, MD listens to Russell Harvie’s heart at MMP MaineHealth Cardiology in Scarborough.
Considering Maine and New Hampshire demographics, MaineHealth has been a natural fit for the age-friendly health system model. According to the U.S. Census Bureau, Maine is the oldest state in the nation, with roughly one in five Mainers over the age of 65 (New Hampshire is roughly at 19% at 65 and over). That number is expected to increase to one in four by the year 2030.
An age-friendly health system adopts four elements of high-quality care, known as the “4Ms.” The “4Ms” act as a framework used to focus on the needs of older adults: What Matters, Mentation, Medication, and Mobility. By incorporating a “What Matters” conversation, an evidence-based practice for providing care, care team members can better understand what matters to the people they care for. Their needs and goals are brought to the forefront, exemplifying MaineHealth’s value of patient centered care.
The Age Friendly Health System framework within MaineHealth was originally piloted at Maine Medical Center. Within the past year, a mechanism for documenting What Matters was built into the electronic medical record so that the information travels with the patient, no matter which provider accesses their record. In the ambulatory setting, age-friendly questions and screening for the 4Ms are now integrated with annual wellness visits and a dashboard was created to help measure this work. MaineHealth continues to expand this work in the inpatient, long term care, and outpatient/ambulatory settings. Read below to learn just one example of the importance of aligning goals through What Matters.
4Ms framework: source: Resources to Practice Age-Friendly Care | IHI – Institute for Healthcare Improvement
Why “What Matters,” Matters
I recently cared for an older man having a heart attack. While I believed that his diagnosis and care plan was obvious, this calm and competent retired accountant had his own clear wishes about how to treat his condition. After thanking the cardiology team for promptly coming to the bedside, he and I spent time talking about what mattered to him.
I assumed that this independent man who enjoyed cooking and reading would want whatever interventions we thought he should have. I assumed wrong. I learned about his life, his family, and his desire against any additional medical interventions. In fact, I couldn’t convince him to spend even one night in the hospital for stabilization. What mattered to him was not what mattered to us, and that’s exactly the point. He enjoyed another six months of life the way he wanted, the way it mattered to him.
Robert Anderson, MD
Maine Medical Center Emergency Physician