Background: The fragmented US healthcare system leads to high rates of errors, especially for older patients. In 2017, multiple health institutions collaborated to create an age-friendly framework, named the 4Ms. To help ensure reliable care, the 4Ms framework consists of what matters, medications, mentation and mobility (1). Beginning in 2025, CMS will require hospital reporting of these age-friendly elements (2). Hospital at Home (HaH) provides inpatient-level care to patients in the comfort of their homes, substituting hospitalization. This unique clinical model can help bridge the gap between inpatient and outpatient settings. This study assesses how HaH care meets the elements of age-friendly care.
Methods: We performed a retrospective review of 50 unique patients who were admitted to our institution’s Hospital at Home service in the last 12 months. Patients were randomly selected if they met selection criteria if they were at least 65 years old and admitted to HaH directly from the Emergency Room. One selected patient was escalated within 24 hours of admission and was excluded from further analysis. Variables collected were the pre-defined elements within the 4M framework, including demographic data and related documentation. Specifically: What Matters – Documented goals of care discussion in the EMR, documented Healthcare Proxy (HCP)/Surrogate, involvement of a caretaker in daily care, Code Status; Medication – medication reconciliation, detection of medication discrepancies, unintentional high-risk medication discrepancies; Mentation- documentation of mental status assessment; Mobility – functional assessment, and new PT or OT evaluation while on HaH.
Results: We reviewed 49 unique charts. The demographics of these selected patients were similar to our overall HaH population with a mean age of 70, primarily female and an average length of stay of 4.7 days. 50% (25) of patients received primary or secondary Medicaid insurance, 30% (15) preferred a language other than English and 35% (17) lived alone. All of the 4M domains had at least 1 element completed in all reviewed admissions. All patients had an active code status, 35 (75%) of patients had others (family, friends or other caretakers) involved in their daily care and 34 (69%) of patients had an HCP or surrogate documented. All patients had a medication reconciliation done with 41% of patients having medication discrepancies. Of these, 6 were considered high-risk medication previously not on their medication lists. All reviewed had a mobility status documented and 19 (39%) had new therapy evaluations while on HaH. All patients had a mental status assessment documented.
Conclusions: The Hospital at Home population described is racially diverse and economically disadvantaged. This model of care employs age-friendly care with high consistency, suggesting it provides a significant degree of patient-centered care. However, more studies and interventions are needed in this area to ensure age-friendly care is provided to all patients throughout their medical journey.
