Two years ago, Case Western Reserve and CVS Health began mapping out a plan to enhance care for the increasing number of older adults treated by nurse practitioners and physician assistants.
Now, they’re putting that plan into action at 1,100 MinuteClinic locations across the United States, the nation’s largest retail ambulatory care network.
Funded by a new three-year, $2.44 million JAHF grant, researchers and planners at the nursing school will work with MinuteClinic to integrate into a clinic visit the “4Ms” framework (What Matters, Medication, Mentation and Mobility)—the age-friendly initiative’s cornerstone approach designed to be equally effective in acute care and ambulatory settings.
The team, with assistance from IHI, will work with providers at MinuteClinic to incorporate the age-friendly concepts into their day-to-day care for older adults and track their implementation at all retail locations.
“What this means for the consumer, the older adult who is coming to the clinic for basic health care, is that he or she will be cared for in a way that honors the specific needs of that population,” said Mary Dolansky, associate professor and director of the QSEN (Quality Safety Education for Nurses) Institute at the nursing school, who is leading the project. “What it means for us is that we will be coaching more than 3,000 providers to focus on caring for an older population and measuring competence in that care.”
Many of the MinuteClinics’ providers are nurse practitioners, she said, giving the Case Western Reserve nursing team particular insight into that work force.
“By applying the 4Ms, MinuteClinic providers will be able to positively impact many of our patients, in a comfortable and familiar setting,” said Angela Patterson, chief nurse practitioner officer, MinuteClinic, and vice president, CVS Health. “Through collaboration with The John A. Hartford Foundation, the Frances Payne Bolton School of Nursing, and the Institute for Healthcare Improvement, MinuteClinic will be the largest retail clinic network in the U.S. to adopt the 4Ms system-wide.”
Case Western Reserve researchers will also observe how providers are integrating age-friendly practices into their daily work, Dolansky said.
What is ‘age-friendly?’
Among the most valuable components of those practices is “spending time finding out what matters to the patient—not just what brought them to the clinic that day, such as a sore throat or cough, but also what really matters most in their life,” said Robin Hughes, an adult gerontology primary care nurse practitioner at the Frances Payne Bolton School of Nursing school and project manager for the grant.
Hughes said providers would use the Age-Friendly 4Ms Framework, along with an American Geriatrics Society standard known as the Beers Criteria®, to guide them. For example, they would use the criteria to identify and address high-risk medications that may not be safe for older adults.
“Some of these medications can cause confusion, sleepiness and even an unsteady gait, which could then lead to a fall and affect their daily routine and what matters to them,” Hughes said. “Assessing the 4Ms as a set and acting on findings is part of what it means to provide age-friendly care.”
Equipping health care providers—specifically those at retail clinics such as MinuteClinic—to better serve older adults is an industry trend. Retail clinics long served primarily younger clients who do not have a primary care provider, offering care for routine issues such as vaccinations, physicals and mild illnesses. But they began to see the average age of their customers rising over the years.
“More than 10,000 people turn 65 every day in this country, which is why we need age-friendly care in MinuteClinics and every care setting,” said Terry Fulmer, president of The John A. Hartford Foundation. “The outstanding work of the Frances Payne Bolton School of Nursing in partnership with CVS Health is a game-changer for older adults across the country who will get the care they need and deserve.”
Dolansky said the health care industry has long focused on the physical health of older patients, but now we know that considering physical and mental/emotional health is needed in order to provide age-friendly care by aligning these in the treatment plan with what matters most.
“We don’t routinely talk about things like cognitive decline and depression and we don’t provide enough guidance for our providers to focus on age-friendly practices for older adults,” she said. “We have to address these things. We cannot ignore them.”
Dolansky said that’s what makes this project with MinuteClinic so significant: “It’s starting here,” she said, “but it’s a movement that we believe will spread.”