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Publication Briefs

Reduced 30-Day Risk of Hospital Readmission Among Veterans Receiving Age-Friendly Health Systems "4Ms" Care


BACKGROUND:
Age-Friendly Health Systems (AFHS) follow a framework that includes assessing the "4Ms" (What Matters, Medications, Mobility, and Mentation) for older patients. VA is the largest integrated AFHS in the country, with more than 400 engaged teams across 170 VAMCs. Although each of the 4Ms is an evidence-based practice, the reporting of outcomes for people who receive assessment of all 4Ms has been limited. In this study, investigators used electronic health records from six VA medical centers to compare the outcomes of 2,420 Veterans who were admitted to inpatient wards from January 2022 to December 2024 and received documented 4Ms care against a matched cohort of 4,688 Veterans who did not receive 4Ms care. The cohorts had matching facility, admission quarter, and year in addition to a propensity score based on covariates including demographics and comorbidities. Investigators examined the cohorts' 30-day readmission rates, emergency department (ED) use, and mortality.

FINDINGS:

  • Veterans who received AFHS care with 4Ms assessments had a lower 30-day risk of hospital readmission (28%) compared to matched Veterans who did not receive 4Ms care (40%).
  • The cohorts had similar 30-day risks of ED visits and mortality.
  • Results were similar in the subgroup of Veterans with dementia and when excluding those who received one to three of the 4Ms assessments in the control group.

IMPLICATIONS:

  • The findings provide real-world evidence that AFHS 4Ms care can improve meaningful clinical outcomes in older Veterans, and highlight the importance of providing, implementing, and measuring AFHS evidence-based practices in inpatient care sites.

LIMITATIONS:

  • This study establishes association but not causation.
  • Veterans were not randomly selected for the intervention; unmeasured Veteran characteristics or components of medical care may account for some of the observed differences.

AUTHOR/FUNDING INFORMATION:
This study was partially funded by HSR and QUERI. Drs. Bayer and Rudolph, Mr. Halladay, and Mss. Barber and Hayes are with HSR’s Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE). Drs. Davila, Mengeling, and Rudolph are with QUERI’s Charleston, Providence, and Iowa City Center for Evidence Evaluation (CPIC). Drs. Davila and Mengeling are also with HSR’s Center for Comprehensive Access & Delivery Research and Evaluation (CADRE).


Bayer TA, Barber M, Halladay C, Rowneki M, Davila H, Mengeling M, Hartronft S, Rudolph JL, Hayes KN. Post-hospitalization Outcomes for Veterans Receiving Age-Friendly Health Systems 4M Care. Journal of the American Geriatrics Society. 2026 Jan;74(1):220-226. Epub October 16, 2025.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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