Assessing Equitable Adherence to the Age-Friendly Health System's 4Ms Framework in an Academic Inpatient Setting.

Area of Science:

• Geriatric Medicine
• Health Services Research
• Health Equity

Background:

• Thousands of health systems use the Age-Friendly Health System's 4Ms Framework to improve care for older adults.
• Consistent adherence to the 4Ms care processes is crucial for effective implementation.
• Understanding mechanisms influencing adherence is key to achieving equitable care.

Purpose of the Study:

• To identify and assess mechanisms influencing adherence to the 4Ms Framework.
• To examine the association between implicit biases and 4Ms adherence.
• To evaluate the impact of comprehensive geriatrics care on adherence.

Main Methods:

• Retrospective, observational study of 28,833 inpatient encounters (patients 65+) at UCSF Health System over 3 years.
• Least squares regression models used to assess associations between 4Ms adherence and patient/encounter characteristics.
• Hypothesized mechanisms included implicit biases and comprehensive geriatrics care contact.

Main Results:

• Overall encounter-level adherence to the 4Ms Framework was 65.5%.
• Negative implicit biases were linked to lower adherence in obese patients and those on Medicaid.
• Positive implicit biases correlated with higher adherence in the oldest old (85+) and patients with reduced mobility.
• Comprehensive geriatrics care contact (ACE unit, geriatrics consult) was associated with significantly higher adherence (5.33 PP).

Conclusions:

• Implicit biases, both positive and negative, appear to influence 4Ms adherence.
• Contact with comprehensive geriatrics care demonstrates a strong positive association with adherence.
• These findings can inform strategies for equitable delivery of age-friendly care.