Institute For Healthcare Improvement Research Articles

Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic.

Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.

Compliance to ventilator care bundles and its association with ventilator-associated pneumonia

PurposeVentilator care bundles are effective in the prevention of ventilator-associated pneumonia (VAP). However, the compliance of these bundles in intensive care units (ICUs) remains poorly studied. This study investigates the Medical Information Mart for Intensive Care (MIMIC)-IV cohort’s compliance with the Institute for Healthcare Improvement (IHI) bundle and its resulting association with VAP incidence.MethodsThis is a retrospective cohort study of the MIMIC-IV database. Patients with > 48 h of invasive mechanical ventilation (IMV) were included. Diagnosis of VAP was identified with the International Classification of Diseases (ICD)-9 and ICD-10 codes. Compliance rates to the IHI bundle were extracted. The association of the IHI bundle and its individual interventions with VAP incidence was analyzed with univariate and multivariate analysis.Results8270 patients were included, of which 1328 (16.1%) had VAP. 25 patients (0.3%) had full compliance to the IHI bundle. 137 patients (1.7%) received no interventions from the bundle. Gastroprophylaxis had the lowest (2.1%) while head elevation had the highest (89.3%) compliance rates. In patients receiving the IHI bundle, each additional intervention was associated with lower VAP incidence (OR [odds ratio] = 0.906, 95% CI [confidence interval] 0.847–0.969). Appropriate sedation levels (OR = 0.765, 95% CI 0.661–0.885) and the use of heat and moisture exchanger (HME) filters (OR = 0.862, 95% CI 0.745–0.998) were individually associated with reduced VAP incidence, while active humidification was individually associated with increased VAP incidence (OR = 1.139, 95% CI 1.001–1.296).ConclusionThe use of the IHI bundle was associated with a lower incidence of VAP, but compliance with the bundle was poor. Appropriate sedation and HME filters were individually associated with reduced VAP incidence. Better compliance with the IHI bundle may reduce VAP rates in mechanically ventilated patients.Graphical

Assessing mid-career female physician burnout in the military health system: finding joy in practice after the COVID-19 pandemic

BackgroundRates of physician burnout increased during the COVID-19 pandemic and are expected to continue to rise. Mid-career physicians, female physicians, and military physicians have all been identified as potentially vulnerable populations to experience burnout. We examine factors associated with physician burnout among this intersectional group through a qualitative key informant interview study.MethodsWe developed a semi-structured interview guide using the Institute for Healthcare Improvement’s Improving Joy in Work Framework and recruited military, mid-career female physicians who worked in the Military Health System(MHS) during the COVID-19 pandemic, (March 2020 -December 2021). Notes were collated and deductive thematic analysis was conducted.ResultsWe interviewed a total of 22 mid-career female physician participants. Participants were between 30 and 44 years of age and 7 were mothers during the pandemic. Most were White and served in the Army. All participants discussed the importance of building rapport and having a good relationship with coworkers. All participants also described their discontentment with the new MHS GENESIS electronic health record system. An emerging theme was military pride as most participants were proud to serve in and support the military population. Additionally, participants discussed the negative impact from not feeling supported and not feeling heard by leadership.ConclusionsMuch like providers in other health systems during the pandemic, MHS physicians experienced burnout. This study allowed us to gather key insights to improve policies for active duty service mid-career female military physicians. Provider inclusion, autonomy, and work culture play critical roles in future systems improvement and workforce retention.

Screening for Quality of Life in a Neurology Tic Clinic Using Quality Improvement Methodology

BackgroundTic disorders in children often co-occur with other disorders that can significantly impact functioning. Screening for quality of life (QoL) can help identify optimal treatment paths. This quality improvement (QI) study describes implementation of a QoL measure in a busy neurology clinic to help guide psychological intervention for patients with tics. MethodsUsing QI methodology outlined by the Institute for Healthcare Improvement, this study implemented the PedsQL Generic Core (4.0) in an outpatient medical clinic specializing in the diagnosis and treatment of tic disorders. Assembling a research team to design process maps and key driver diagrams helped identify gaps in the screening process. Conducting several plan-do-study-act cycles refined identification of patients appropriate to receive the measure. Over the three-year study, electronic health record notification tools and data collection were increasingly utilized to capture patients’ information during their visit. ResultsOver 350 unique patients were screened during the assessment period. Electronic means replaced paper measures as time progressed. The percentage of patients completing the measure increased from 0% to 51.9% after the initial implementation of process improvement, advancing to 91.6% after the introduction of electronic measures. This average completion rate was sustained for 15 months. ConclusionsUsing QI methodology helped identify the pragmatics of implementing a QoL assessment to enhance screening practices in a busy medical clinic. Assessment review at the time of appointment helped inform treatment and referral decisions.

Metabolic bone disease of prematurity screening and individualized enteral mineral supplementation in high-risk neonates: a quality improvement initiative.

Prompted by an alarmingly low screening rate for metabolic bone disease of prematurity (MBDP), we aimed to increase MBDP screening with serum calcium, phosphorous, and alkaline phosphatase at four to six weeks of life in infants born at <1500 g and <32 gestational weeks from a baseline of 27.37% to 90% within one year. We used the Institute for Healthcare Improvement's Model for Improvement as a framework. A key driver diagram informed the interventions which were carried out through four Plan-Do-Study-Act cycles. There were 129 and 130 neonates in the pre-intervention baseline group and post-intervention MBDP bundle group, respectively. MBDP bundled primary screening rates increased from 27.37% to 95.56% (p < 0.001). Furthermore, 20% of infants had an individualized change in their enteral mineral supplementation after the initiative. An interdisciplinary team-based quality improvement approach was effective in altering clinical practice to improve screening and subsequent treatment for MBDP.

Health Care Professional Distress and Mental Health: A Call to the Continuing Professional Development Community.

COVID-19 unleashed a maelstrom of distress on health care professionals. The pandemic contributed to a host of stressors for workers because of the need for rapid acquisition of new knowledge and skills to provide best treatment while simultaneously dealing with personal safety, limited resources, staffing shortages, and access to care issues. Concurrently, problems with systemic racial inequality and discrimination became more apparent secondary to difficulties with accessing health care for minorities and other marginalized groups. These problems contributed to many health care professionals experiencing severe moral injury and burnout as they struggled to uphold core values and do their jobs professionally. Some left or disengaged. Others died. As continuing professional development leaders focused on all health professionals, we must act deliberately to address health care professionals' distress and mental health. We must incorporate wellness and mental health as organizing principles in all we do. We must adopt a new mental model that recognizes the importance of learners' biopsychosocial functioning and commit to learners' wellness by developing activities that embrace a biopsychosocial point of view. As educators and influencers, we must demonstrate that the Institute for Healthcare Improvement's fourth aim to improve clinician well-being and safety (2014) and fifth aim to address health equity and the social determinants of health (2021) matter. It is crucial that continuing professional development leaders globally use their resources and relationships to accomplish this imperative call for action.

Establishing a trigger tool based on global trigger tools to identify adverse drug events in obstetric inpatients in China

BackgroundPregnant women belong to the special population of drug therapy, and their physiological state, pharmacokinetics and pharmacodynamics are significantly different from the general population. Drug safety during pregnancy involves two generations, which is a hot issue widely concerned in the whole society. Global Trigger Tool (GTT) of the Institute for Healthcare Improvement (IHI) has been wildly used as a patient safety measurement strategy by several institutions and national programs, and the effectiveness had been demonstrated. But only one study reports the use of GTT in obstetric delivery until now. The aim of the study is to establish triggers detecting adverse drug events (ADEs) suitable for obstetric inpatients on the basis of the GTT, to examine the performance of the obstetric triggers in detecting ADEs experienced by obstetric units compared with the spontaneous reporting system and GTT, and to assess the utility and value of the obstetric trigger tool in identifying ADEs of obstetric inpatients.MethodsBased on a literature review searched in PubMed and CNKI from January of 1997 to October of 2023, retrospective local obstetric ADEs investigations, relevant obstetric guidelines and the common adverse reactions of obstetric therapeutic drugs were involved to establish the initial obstetric triggers. According to the Delphi method, two rounds of expert questionnaire survey were conducted among 16 obstetric and neonatological physicians and pharmacists until an agreement was reached. A retrospective study was conducted to identity ADEs in 300 obstetric inpatient records at the Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital from June 1 to September 30, 2018. Two trained junior pharmacists analyzed the first eligible records independently, and the included records reviewed by trained pharmacist and physician to identify ADEs. Sensitivity and specificity of the established obstetric triggers were assessed by the number of ADEs/100 patients and positive predictive value with the spontaneous reporting system (SRS) and GTT. Excel 2010 and SPSS22 were used for data analysis.ResultsThrough two rounds of expert investigation, 39 preliminary triggers were established that comprised four modules (12 laboratory tests, 9 medications, 14 symptoms, and 4 outcomes). A total of 300 medical records were reviewed through the obstetric triggers, of which 48 cases of ADEs were detected, with an incidence of ADEs of 16%. Among the 39 obstetric triggers, 22 (56.41%) were positive and 11 of them detected ADEs. The positive predictive value (PPV) was 36.36%, and the number of ADEs/100 patients was 16.33 (95% CI, 4.19–17.81). The ADE detection rate, positive trigger rate, and PPV for the obstetric triggers were significantly augmented, confirming that the obstetric triggers were more specific and sensitive than SRS and GTT.ConclusionThe obstetric triggers were proven to be sensitive and specific in the active monitoring of ADE for obstetric inpatients, which might serve as a reference for ADE detection of obstetric inpatients at medical institutions.

IMPLEMENTING AGE-FRIENDLY HEALTH SYSTEMS: SCALING 4MS CARE ACROSS VA

Abstract The U.S. Department of Veterans Affairs (VA) provides health care to 9 million enrolled Veterans across a variety of settings. Nearly 50% of enrolled Veterans are age 65 and older, compared to 16% of the U.S. population. The VA has set out to become the largest integrated Age-Friendly Health System (AFHS), using the 4Ms as a framework to improve care for older adults: what Matters, Medication, Mentation and Mobility. When implemented together, the 4Ms allow interprofessional teams and health systems to provide care consistent with what Matters to each older adult. Since joining AFHS movement in 2020, over 190 care settings at 100 VA facilities have earned recognition from the Institute for Healthcare Improvement (IHI). VA has identified key drivers to scale-up and spread 4Ms care at the national, local, and team level. Drivers include active and visible national leadership, building a coalition of local champions, and regular commmunication with teams. VA has accelerated adoption of the 4Ms by following IHI’s Action Community (AC) model. At close of registration, 145 teams from 69 VA facilities enrolled in the VA AC. The VA AC offered a series of monthly webinars and coaching calls to empower teams to create a 4Ms plan building on exisiting best practices. In addition to using evidence-based tools identified by IHI, teams may also leverage VA clinical innovations to support their 4Ms plan. Implementation of AFHS provides a framework for interdisciplinary teams to continuously improve Veteran-centered care and ultimately, fulfill VA’s mission to honor America’s aging Veterans.

INTEGRATING AGE-FRIENDLY CARE INTO THE ONCOLOGY CONTINUUM

Abstract The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.

CONDUCTING A NEEDS ASSESSMENT TO INFORM AGE-FRIENDLY HEALTH SYSTEMS INITIATIVE FOR UNIVERSITY OF UTAH HEALTH

Abstract Today, people live longer and more productive lives than ever. The number of adults aged 65 and older is projected to nearly double 98 million by 2060 to 24% of the U.S. population (Administration on Aging &amp; Administration for Community Living, 2018). Increased life expectancy, coupled with the exponential growth of the older adult population will create more demand for healthcare professionals to meet the care needs of older adults living with chronic conditions. Chronic conditions can lead to complex care and increase the usage of healthcare systems (Axon &amp; Kamel, 2021). The Age-Friendly Health Systems initiative provides specific evidenced-based best-practice interventions to all older adults in a health system setting (Fulmer et al., 2022). An Age-Friendly Health System is one in which every older adult’s care is guided by an essential set of evidence-based practices known as the 4Ms framework: What Matters, Medications, Mentation, and Mobility (Institute for Healthcare Improvement, 2022). This project developed and delivered a Needs Assessment to providers practicing in the U Health Ambulatory Care Clinics to identify baseline knowledge, gaps in knowledge, and current practices related to the AFHS 4Ms Framework. The Needs Assessment consists of using online surveys and semi-structured interviews. Significant findings were that: 1) U Health ambulatory care clinic providers have very little to no baseline knowledge of the AFHS 4Ms Framework, 2) U Health ambulatory care providers are already providing care that aligns with the 4Ms framework, 3) There are barriers and challenges to providing Age-Friendly care.

THE LTSS STATE SCORECARD AND AGE-FRIENDLY CARE

Abstract Age-friendly care is health care that addresses a person’s unique needs and wants across the lifespan. It is a critical part of the age-friendly ecosystem. Rooted in the essential elements known as the “4Ms” (what Matters, Medication, Mentation, and Mobility), age friendly care is critical to successful delivery systems of health care as well as long-term services and supports. For the first time in its history, the LTSS State Scorecard will measure states as it relates to the presence of Age-Friendly Health System sites. Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, and helps hospitals, doctor’s offices, retail pharmacy clinics, nursing homes, and home-care providers deliver age-friendly care. This portion of the symposium will describe Scorecard findings on Age-Friendly Health Systems and address more broadly the important role of age-friendly care in LTSS.

Characteristics and Percentage of 30 Days All Cause Hospital Readmissions in Mongolia

Objective: This study aimed to estimate the 30 days readmissions and predictors of readmission at selected referral hospitals in Mongolia. Methods: We studied the electronic medical recording database of patients admitted to The State First Central Hospital of Mongolia, The State Second Central Hospital of Mongolia, and The State Third Central Hospital of Mongolia, from January 01, 2023, to June 30, 2023. The Institute for Healthcare Improvement’s Whole system measures white paper adopted the measurement methods for hospital readmission percentages. A descriptive analysis was conducted to calculate the percentage of hospital readmissions. We examined principal diagnoses, length of stay and age and gender are variables. Results: 31,675 hospital discharged data were recorded in hospitals over the 6-month study period. The average readmission percentage across the three hospitals were 1988 (6.3%). Most of the principal diagnosis leading to readmissions were cancer and chronic diseases.Conclusion: The highest hospital readmission rates were observed in patients with cancer and chronic diseases, particularly among individuals aged 46-64 years in the referral hospitals.

Age-Friendly Framework in Post-Acute and Long-Term Care: Implementing the 4Ms in Long-Term Care

Age-Friendly Health Systems is an initiative of 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 that uses a framework to ensure high-quality, person-centered care for older adults. The framework, called the 4 Ms, includes what matters, mobility, medications, and mentation. This work outlines a practical, evidence- based approach to implementing 4 Ms care in long-term care (LTC).

Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days.

Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff. Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center. Program evaluation. A total of 172 PCPH team members: providers (n = 55), staff (n = 99), and medical learners (n = 18) in the Stanford Division of Primary Care and Population Health (PCPH) clinics, 2018-2021. We categorized projects by the Institute for Healthcare Improvement's (IHI) Quintuple Aim (QA): better health, better patient experience, lower cost of care, better care team experience, and improved equity/inclusion. We assessed project progress with a modified version of The Ottawa Hospital Innovation Framework: step 1 (identified root causes), step 2 (designed/tested interventions), step 3 (assessed project outcome), step 4 (met project goal with target group), step 5A (intervention(s) spread within clinic), step 5B (intervention(s) spread to different setting). Participants rated post-participation QI self-efficacy. Within 1000days, 172 unique participants completed 104 PC-PEP projects. Most projects aimed to improve patient health (55%) or care team experience (23%). Among projects, 9% reached step 1, 8% step 2, 16% step 3, 26% step 4, 21% step 5A, and 20% step 5B. Learner involvement increased likelihood of scholarly products (47% vs 10%). Forty-six of 47 (98%) survey respondents reported improved QI self-efficacy. Medical assistants, more so than physicians, reported feeling acknowledged by the health system for their QI efforts (100% vs 61%). With appropriate QI infrastructure, scalable QI training models like Stanford PC-PEP can empower frontline workers to create meaningful changes across the IHI QA.

Equity and Performance Improvement: A Novel Toolkit That Makes Using an Equity Lens the Default

Performance improvement methodologies do not currently include any structures that encourage analysis of how bias, inequity, or social determinants of health (SDOH) contribute to outcomes. The Montefiore Center for Performance Improvement developed a novel quality improvement (QI) toolkit that ingrains issues of diversity, equity, and inclusion (DEI) and SDOH into the Institute for Healthcare Improvement's tools. The toolkit prompts QI teams to evaluate DEI and SDOH at each step of the journey, including an updated charter and stratified baseline tool, a new fishbone diagram for the discovery phase with a tail to include DEI and SDOH, and additions in the Study and Act sessions of the Plan-Do-Study-Act worksheet to address these issues. After development and dissemination of this toolkit, the authors conducted a pre-post analysis of projects conducted by QI fellows in their institution. Prior to introducing the new toolkit, 22.9% of projects from 2016 to 2021 incorporated DEI/SDOH into any stage of the QI process. After implementing the amended tools, this increased to 88.9% in the 2022 fellowship. These results show that this simple approach can hardwire consideration of DEI and SDOH into improvement projects.

Transforming health care: A large health organizations' journey to become an age-friendly health system (AFHS) and beyond.

In 2017, the John A. Hartford Foundation partnered with the Institute for Health Care Improvement, American Hospital Association, and Catholic Health Care Organization to define the 4Ms framework to improve quality of care and health outcomes for older adults. The senior leadership of one of the largest integrated healthcare organizations (HCO) in the country recognized the relevance of these recommendations to the aging demographic of the United States. The health system provides care to over 2,000,000 unique patients annually, about 20% of whom are aged ≥65. We describe how commitment to becoming an Age-Friendly Health System (AFHS) has taken this HCO beyond the targets set by the initiative. Steps guiding evolution of the AFHS model of care are as follows: Initiation, assessment, planning, implementation, sustainability. An AFHS leadership team including geriatrics and quality improvement expertise oversees the initiative. Plan-Do-Study-Act cycles are utilized at multiple stages to develop structures for data collection and reporting outcomes. Initiation and assessment stages identified key champions and existing efforts and programs that were leveraged to implement 4Ms best practices. Working committees with relevant expertise for each M selected evidence-based quality measures and designed/adapted training materials. The EHR is used to integrate quality measures and gather outcome data to inform changes in care. Dashboards capturing quality measures for each M have been implemented and pilot-tested at a community-based hospital and these processes are being adapted and disseminated to other settings. Leadership and stakeholders convene regularly to review lessons learned and next steps. On the health system level, partnering with quality management leaders has led to development of processes that feed into organizational level data used to track longitudinal improvements in patient outcomes. Outcome data in each of the 4M domains are presented. Learning points are shared to help others take a systems-approach to age-friendly change.

Optimizing delirium care in the era of Age-Friendly Health System.

Delirium is a significant geriatric condition associated with adverse clinical and economic outcomes. The cause of delirium is usually multifactorial, and person-centered multicomponent approaches for proper delirium management are required. In 2017, the John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) launched a national initiative, Age-Friendly Health System (AFHS), promoting the use of a framework called 4Ms (what matters, medication, mentation, and mobility). The 4Ms framework's primary goal is to provide comprehensive and practical person-centered care for older adults and it aligns with the core concepts of optimal delirium management. In this special article, we demonstrate how a traditional delirium prevention and management model can be assessed from the perspective of AFHS. An example is the crosswalk with the Hospital Elder Life Program (HELP) Core Interventions and the 4MS, which demonstrates alignment in delirium management. We also introduce useful tools to create an AFHS environment in delirium management. Although much has been written about delirium management, there is a need to identify the critical steps in advancing the overall delirium care in the context of the AFHS. In this article, we suggest future directions, including the need for more prospective and comprehensive research to assess the impact of AFHS on delirium care, the need for more innovative and sustainable education platforms, fundamental changes in the healthcare payment system for proper adoption of AFHS in any healthcare setting, and application of AFHS in the community for continuity of care for older adults with delirium.

Quality Assurance and Safety Culture in a Healthcare Organization

Patient care and quality management have as one of their primary focuses ensuring the safety of their patients. The four principles of biomedical ethics presented by Beauchamp and Childress are one quality management paradigm that emphasizes the importance of the patient. The Institute of Medicine's six improvement goals capture the essence of excellent medical treatment. Care, money, and health are the three pillars upon which the Institute for Healthcare Improvement's Triple Aim rests. The present review was written with the aforementioned contexts in mind, with the intention of highlighting the system's initiatives to address various efforts of enhancing quality and patient safety. We provide a reflective overview of healthcare legislation, policy, and regulation with special attention paid to the ideas of informed consent and informed refusal. This analysis also details the steps taken and regulations enforced by the administration and management to provide care that is focused on the individual patient. Finally, we discuss model policies like the Delivery System Reform Incentive Payment Program, which incorporates quality management frameworks, the Hospital-Acquired Conditions Reduction Program, which promotes patient safety, and the Hospital Readmissions Reduction Program, which aims to reduce hospital readmissions.

Collaborative Learning Among Health Care Organizations to Improve Quality and Advance Racial Equity.

The study examined stakeholder experiences of a statewide learning collaborative, sponsored and led by Blue Cross Blue Shield of Massachusetts (BCBSMA) and facilitated by the Institute for Healthcare Improvement (IHI) to reduce racial and ethnic disparities in quality of care. Interviews of key stakeholders (n=44) were analyzed to assess experiences of collaborative learning and interventions to reduce racial and ethnic disparities in quality of care. The interviews included BCBSMA, IHI, provider groups, and external experts. Breast cancer screening, colorectal cancer screening, hypertension management, and diabetes management were focal areas for reducing disparities. Collaborative learning methods involved expert coaching, group meetings, and sharing of best practices. Interventions tested included pharmacist-led medication management, strategies to improve the collection of race, ethnicity, and language (REaL) data, transportation access improvement, and community health worker approaches. Stakeholder experiences highlighted three themes: (1) the learning collaborative enabled the testing of interventions by provider groups, (2) infrastructure and pilot funding were foundational investments, but groups needed more resources than they initially anticipated, and (3) expertise in quality improvement and health equity were critical for the testing of interventions and groups anticipated needing this expertise into the future. BCBSMA's learning collaborative and intervention funding supported contracted providers in enhancing REaL data collection, implementing equity-focused interventions on a small scale, and evaluating their feasibility and impact. The collaborative facilitated learning among groups on innovative approaches for reducing racial disparities in quality. Concerns about sustainability underscore the importance of expertise for implementing initiatives to reduce racial and ethnic disparities.

Lessons Learned from Age-Friendly, Team-Based Training.

According to the Institute of Medicine, immediate steps must be taken across the United States to educate and train the healthcare workforce to work collaboratively to address the needs of the growing older adult population. The Geriatric Practice Leadership Institute (GPLI) was designed to support professional teams working in acute and post-acute care in transforming their organization into a designated Age-Friendly Health System. The program was built around the Institute for Healthcare Improvement's Age-Friendly Health Systems 4Ms framework. This framework focuses on What Matters, Medication, Mentation, and Mobility (the 4Ms) in supporting care for older adults. The GPLI program is an online, seven-month team-based program with four to seven participants from one organization per team. Additionally, each team selected, developed, and completed a quality improvement project based on Age-Friendly Health Systems 4Ms. The curriculum also includes organizational culture, leadership, and interprofessional team-building modules. Using a post-completion survey, the experiences of 41 participants in the GPLI program were assessed. All respondents found the information in the program 'very' or 'extremely' valuable, and their executive sponsor 'very' or 'extremely' valuable in supporting their team's involvement and project. The GPLI program has trained over 200 healthcare professionals and teams that have successfully implemented projects across their organizations.