Two OU Health Physicians Clinics Earn Age-Friendly Certification

Two OU Health Physicians clinics in Oklahoma City have earned Level 1 certification as an Age-Friendly Health System, an ongoing initiative designed to improve the care of older adults.

The Senior Health Clinic and the General Internal Medicine Clinic at OU Health Physicians received the designation from the Institute for Healthcare Improvement, which works to improve and sustain better health outcomes for people across the world.

The four essential elements of an Age-Friendly Health System are known as the 4Ms:

• What Matters: Asking older adults what matters most to them and aligning care with those goals in mind.
• Medication: Using age-friendly medications that do not interfere with what is important to the older adult.
• Mentation: Preventing, identifying, treating and managing dementia, delirium, depression and other mental health issues.
• Mobility: Ensuring older adults move safely every day and maintain their function for activities that are important to them.

"Asking our patients what matters to them sets the stage for the other three M's and ensures that our care is patient-centered. We want to make sure that the care we provide helps people be as functional as possible, as independent as possible, for as long as possible," said geriatrician Lee Jennings, M.D., Chief of the Section of Geriatrics in the Department of Medicine of the OU College of Medicine.

When patients are asked what matters to them, their answers vary but are often related to family activities. One patient, for example, said his main goal was to be able to walk to the baseball field to watch his grandson play. But his medical conditions still needed treatment.

"As physicians, sometimes we tell patients they should be on a particular medication because that's what has been shown to benefit their condition," said Brian Lich, M.D., an internal medicine physician and assistant professor in the OU College of Medicine. "But the man watching his grandson play baseball wanted to be able to walk to the field without falling, without getting too short of breath, and without having to stop every few feet. That led me to consider which medications would be best for what he wanted to do. The 4Ms framework helps me and the patient to meet each other's goals and expectations, as opposed to it being a one-way street where I'm telling them what to do."

Another patient with a hip fracture wanted to ensure he could continue living on his own without needing help with daily activities like getting dressed or going to the bathroom, Jennings said. Physical therapy would be painful, but it was the best option for regaining his strength and mobility. "After talking through what was important for him, the patient understood that while the physical therapy would make him tired and hurt at times, it was important for the independence he wanted to achieve," she said.

The care of older adults is often complex because they tend to have multiple conditions. A treatment for one condition may exacerbate another or cause an unwanted side effect, such as fatigue or sedation from a medication. Sometimes trade-offs must be made, but the 4Ms framework helps in decision-making. The approach also sets the stage for conversations about a patient's wishes should their health take a turn for the worse.

"When you've been talking to patients about what matters most to them, it's more natural to have conversations about what kind of care or interventions they want if they get really sick," Lich said. "Instead of asking them about whether they want to be resuscitated or intubated in a critical situation, without much context behind the question, we've been having conversations all along about what type of care will best help them meet their goals."

The 4Ms framework is embedded in the electronic health record for OU Health Physicians, allowing physicians to track their patients' improvement over time. Because the clinics are part of an academic health system, students and residents will learn about the 4Ms and carry them forward into their own careers.

"During their training, students and residents learn how to treat many different conditions, but by starting with asking the patient what matters to them, it highlights the best care for the patient," Lich said. "It's an opportunity to teach high-quality, patient-centered care of older adults."

The OU Health hospital system, including the University of Oklahoma Medical Center and Edmond Medical Center, have also been named an Age-Friendly Health System, the first in Oklahoma to achieve the certification.