Evaluation of education initiatives to increase delivery of age-friendly care in retail clinics

IF 4.5 2区医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-07-17 DOI:10.1111/jgs.19081

Nicholas K. Schiltz PhD, Grace Q. Armstrong MPH, Megan A. Foradori MSN, RN, Sarah Ball MSN, RN, APRN, FNP-BC, Evelyn G. Duffy DNP, AGPCNP-BC, FAANP, Mary E. McCormack MSN, MPH, RN, APNC, Lilia Pino PhD, RN, FNP-C, Anne M. Pohnert DNP, RN, FNP-BC, Mary A. Dolansky PhD, RN, FAAN

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Abstract

Background

The Age-Friendly Health Systems model, encompassing four key elements (4Ms)—What Matters, Medication, Mentation, Mobility—is integral to delivering high-quality care to older adult patients. In May 2020, the MinuteClinic at CVS implemented the 4Ms model in all 1100+ store locations nationwide. To prepare healthcare providers to deliver 4Ms care, educational modules were developed to provide an understanding of the gerontology principles that support the 4Ms model of care. Our goal was to evaluate the effectiveness of these education modules on improving reliable 4Ms delivery during retail clinic visits.

Methods

Educational modules were provided to nurse practitioners and physician associates to complete in a self-directed manner. These included an orientation module with scenarios comparing usual care and 4Ms care, 12 monthly grand rounds focusing on 4Ms case studies, and 10 video vignettes on 4Ms integration. We examined the association between number of education modules completed with the average number of Ms delivered per visit (M-Score) using descriptive statistics and a generalized linear mixed-effects model.

Results

Over 70% of 2783 providers completed at least one education module. Rates of 4Ms care delivery were 1.37 (1.36–1.39, p < 0.001) times higher among those that completed an orientation course compared to those that did not. Higher uptake of education exhibited a dose–response relationship with rate ratios between 1.77 (1.74–1.80, p < 0.001) for 1–2 modules beyond orientation, up to 2.94 (2.90–2.99, p < 0.001) for eight or more modules.

Conclusions

The self-directed learning environment (e.g., providers self-select the number and type of courses) reflects real-world variation in engagement. Despite this variation, significant improvements in 4Ms delivery were observed at any level of educational exposure, underscoring the value of prioritizing education time with quality improvement initiatives.

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评估旨在增加零售诊所老年友好护理服务的教育举措。

背景：老年友好型医疗系统模式包含四个关键要素（4Ms）--重要事项（What Matters）、用药（Medication）、指导（Mentation）、行动（Mobility）--是为老年患者提供高质量医疗服务不可或缺的一部分。2020 年 5 月，CVS 的 MinuteClinic 在全国所有 1100 多家门店实施了 4Ms 模式。为了让医疗服务提供者做好提供 4Ms 护理的准备，我们开发了教育模块，让他们了解支持 4Ms 护理模式的老年学原则。我们的目标是评估这些教育模块在零售诊所就诊期间改善可靠的 4Ms 服务的效果：方法：我们向执业护士和医生提供了教育模块，让他们以自我指导的方式完成。这些教育模块包括一个包含常规护理和 4Ms 护理情景比较的指导模块、12 个以 4Ms 案例研究为重点的每月大查房以及 10 个关于 4Ms 整合的视频片段。我们使用描述性统计和广义线性混合效应模型研究了完成教育模块的数量与每次就诊平均提供的 Ms 数量（M-Score）之间的关系：在 2783 名医疗服务提供者中，超过 70% 的人至少完成了一个教育模块。提供 4Ms 护理的比率为 1.37（1.36-1.39，P 结论）：自主学习环境（例如，医疗服务提供者自主选择课程的数量和类型）反映了现实世界中参与度的差异。尽管存在这种差异，但无论接受何种程度的教育，都能明显改善 4Ms 护理的提供，这突出表明了将教育时间与质量改进措施放在首位的价值。

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.

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