Scaling the Age-Friendly Care 4Ms Framework Across 26 Midwest Hospitals

The rapid growth of the older adult population is placing increasing demands on health systems to deliver coordinated, high-quality, and person-centered care. Older adults frequently present with multimorbidity, cognitive impairment, and functional decline, creating complexity for care teams and increasing risk for adverse outcomes. Delivering consistent, high-quality care in this population requires standardized workflows, interdisciplinary coordination, and approaches that support both patients and clinicians. To address these challenges, Advocate Health - Wisconsin/Illinois Divisions implemented the Age-Friendly Health Systems (AFHS) 4Ms framework consisting of What Matters, Medication, Mentation, and Mobility across 26 hospitals in Wisconsin and Illinois. The initiative focused on embedding the 4Ms into routine inpatient care to improve the reliability of assessment and intervention while aligning care with patient goals. Implementation was supported by a multilevel governance structure that aligned executive leadership, system-level oversight, and frontline teams. Executive sponsors established priorities and accountability, while a system lead, supported by service line leadership, coordinated standardized workflows, education, and performance monitoring. Multidisciplinary advisory input and site-based champions ensured alignment with clinical practice and supported adoption at the point of care. Standardized tools, role-based education, and electronic health record (EHR) integration enabled consistent application within existing workflows. A cohort-based implementation model facilitated phased spread, peer learning, and iterative refinement using quality improvement methods. Data infrastructure, including centralized dashboards and real-time audit tools, supported performance monitoring and rapid-cycle improvement. Across early cohort hospitals, implementation was associated with substantial improvements in the reliability of 4Ms care processes. Documentation of What Matters and cognition screening improved significantly, while medication review to identify potentially inappropriate medications and delirium assessment reached high reliability. Mobility processes also improved, approaching reliable care thresholds. These gains were associated with reductions in delirium rates and length of stay in pre-post analyses. At the system level, similar improvements were observed, demonstrating successful spread and sustained performance across all hospitals. By mid-2025, several 4Ms components achieved high reliability, with continued improvement in overall bundle performance. Key challenges included documentation burden, variability in site adoption, competing priorities, and limitations in measuring interventions. Lessons learned highlight the importance of leadership alignment, workflow integration, interdisciplinary collaboration, EHR-enabled standardization, and data transparency. This case study demonstrates a scalable, systemwide approach to embedding Age-Friendly care into routine hospital practice while improving care reliability and outcomes for older adults.