Post-Hospitalization Outcomes for Veterans Receiving Age-Friendly Health Systems 4M Care

The Age-Friendly Health System movement has been building teams and systems to implement the assessment of the "4Ms" (What Matters, Medications, Mobility, and Mentation). Although each of the 4Ms is an evidence-based practice, the reporting of outcomes for people who receive the assessment of all 4Ms has been limited.

This retrospective matched cohort study included Veterans admitted to six VA medical centers implementing inpatient assessment of the 4Ms from January 2022 to December 2024. Using electronic health records, we identified a cohort of Veterans admitted to inpatient wards and with documented assessment of the 4Ms. Propensity score matching was used to select a matched cohort without complete 4M assessments. The matching algorithm required matching on facility, admission quarter, and year in addition to a propensity score based on covariates including demographics and comorbidities. We selected the AFHS outcomes of 30-day readmission, emergency department use, and mortality. We used Kaplan-Meier methods to estimate cumulative incidence of outcomes and Cox proportional hazard models to estimate hazard ratios.

The propensity matching analysis resulted in 2420 Veterans with 4Ms care and 4688 matched Veterans without (mean age 79 years, 97% male). The matched groups were well balanced. AFHS care with the 4Ms was associated with reduced hazard for readmission (HR 0.67, 95% CI 0.62-0.73) and statistically similar hazard for ED visits in 30 days (HR 0.95, 95% CI 0.82-1.13) and mortality (HR 1.02, 95% CI 0.86-1.21). Results were similar when restricting to those with dementia and excluding those with any of the 4Ms assessments in the control group.

In this retrospective cohort study, AFHS care including assessment of the 4Ms was associated with reduced readmission without changes in emergency department visits or mortality. The results support the effort of implementing AFHS evidence-based practices into inpatient care sites.