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A general combination of strategies to implement or increase the uptake of Age-Friendly Health System (AFHS) may improve some 4Ms process measures. However, there is insufficient evidence to assess the effects of specific strategies, and there is minimal evidence of the influence of AFHS strategies on outcome measures. There is a need to standardize reporting of AFHS implementation strategies, and a need for research to examine the effect of specific AFHS strategies on process and outcome measures.
Delivery of health care services to older adults can be challenging, fragmented and poorly coordinated, which can lead to duplication of services and care that may not address patient-centered needs. In 2017, the AFHS initiative was launched with the goal of improving care and outcomes for older adults. The foundation of AFHS is the "4Ms" Framework focusing on What Matters, Medications, Mentation, and Mobility. This review examined the literature on the contextual factors for implementation of AFHS in outpatient settings, as well as the effect of implementation support strategies on process, outcome, and structural measures of AFHS in outpatient settings.
Ten studies employing 67 strategies to implement AFHS met the eligibility criteria for this review. Barriers to AFHS implementation included challenges with data collection and documentation; difficulty changing culture, engaging team members, or establishing new processes; lack of buy-in or 4Ms knowledge; patient preferences; scheduling/time constraints; and technology barriers, Facilitators included buy-in; administrative support or existing infrastructure; 4Ms knowledge; and partnerships/community support. Using a general combination of strategies to increase the uptake of 4Ms in sites with existing AFHS programming may improve What Matters (low confidence), Mobility (low confidence), and composite 4Ms process measures (moderate confidence). In sites without existing AFHS programming, a general combination of implementation strategies may improve What Matters, Medication, Mentation, and Mobility process measures over time after AFHS implementation (moderate confidence). There is insufficient evidence for the effect of a specific strategy or specific combination of strategies for AFHS implementation in either setting, and no comparative study reported outcome or structural measures. There is a need to standardize reporting of AFHS implementation strategies, and for research to examine the effect of specific AFHS strategies on process and outcome measures.
Implementation of Age-Friendly Health Systems in Outpatient Settings: A Systematic Review (Management Brief)
