An Interdisciplinary Approach to Implementing the Age-Friendly Health System 4Ms in an Ambulatory Clinical Pathway With a Focus on Medication Safety.

MedStar's Center for Successful Aging (CSA) participated in the Age-Friendly Health Systems initiative led by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States. This initiative focuses on bringing the 4Ms framework-What Matters, Medication, Mentation, and Mobility-to caring for older adults. A quality improvement project was conducted at the CSA to integrate the 4Ms framework into the CSA ambulatory clinical pathway. Our interventions found upward trends in patients receiving 4Ms care during their new patient visits. Positive preliminary feedback was also obtained from providers following the incorporation of the 4Ms framework in the high-risk rounds discussion. A focus on high-risk medications and deprescribing illustrated positive clinical outcomes. This ongoing interprofessional collaboration illustrates the importance of person-centered care and quality improvement to achieve Age-Friendly Health Systems status within an ambulatory practice. [Journal of Gerontological Nursing, 46(10), 7-11.].

Patient and Provider Perspectives on Deprescribing Proton Pump Inhibitors.

The aim of the current study is to describe proton pump inhibitor (PPI) prescribing trends in an older adult population and elucidate perspectives regarding PPI deprescribing. A retrospective chart review and a prospective cross-sectional analysis of provider and patient surveys were conducted. The retrospective chart review identified 107 patients age ≥65 who were prescribed PPI therapy. Nineteen patients on PPI therapy and 74 providers completed surveys regarding their perspectives on PPI deprescribing. PPI therapy was potentially inappropriate for 66% of patients based on dose, duration, and/or indication. Provider barriers to deprescribing included fear of outcomes, access to documentation, and uncertainty of current guidelines. This study illustrates the prevalence of long-term PPI use in geriatric patients without associated clinical indications, as well as perceived barriers to deprescribing. Long-term PPI use is associated with significant side effects; therefore, successful deprescribing must address these perceived barriers. [Journal of Gerontological Nursing, 45(10), 9-17.].

Consecutive autopsies on an internal medicine service.

OBJECTIVES: Autopsy rates continue to decline in the United States despite the demonstrated value of this procedure in many different settings. We sought to review clinical pathologic discordance information generated by autopsies on an internal medicine service in the urban United States and to determine whether resident services appear to influence autopsy rates. METHODS: We reviewed consecutive deaths and autopsies on an inpatient internal medicine service during a 30-month period at a 400-bed community hospital in Baltimore, MD. RESULTS: There were 622 deaths and 65 autopsies (10.3%). Resident teaching status correlated with a higher rate of autopsies performed (P = 0.048). Clinical pathologic discordance was common, with a major discordance rate of 39%. Major discordance was indicated by only one of nine autopsies performed on patients with human immunodeficiency virus. CONCLUSIONS: The autopsy was a valuable educational and quality improvement tool on the urban internal medicine service. Residency influences may be a major factor in continuing this exercise. In our study, although the numbers were small, patients with human immunodeficiency virus had a very low discordance rate.