An Implementation Maturity Survey to Support Systemwide Age-Friendly Care

Thousands of organizations across the United States are implementing the 4Ms (What Matters, Medication, Mentation, and Mobility) framework to improve care for older adults but are making different decisions about how they approach such implementation. This variation makes it difficult to compare progress and generate cohesive evidence about enablers of progress and impact on outcomes. The authors developed a 4Ms implementation maturity framework and associated survey instrument to capture real-world data on 4Ms implementation progress. The authors then conducted a pilot administration of the survey with the 30 health systems participating in the Institute for Healthcare Improvement's Age-Friendly Health System Scale and Spread Collaborative. For each respondent (N=18; 60% response rate), a setting-specific, continuous, weighted score of 4Ms implementation maturity was calculated. Each care process within each M received an incremental score based on measured progress, which was then weighted and summed to create scores between 0 and 1 for each M and for the 4Ms as a singular composite. These scores were designed to be specific to describing maturity within an organization's clinical sites that had initiated 4Ms work (i.e., focusing on depth of implementation work within active sites rather than reach across the footprint of the organization). Implementation was most mature in geriatric-specific inpatient settings (median of 0.66), followed by a median score of 0.63 in nongeriatric inpatient settings, 0.47 in geriatric ambulatory settings, and 0.36 in nongeriatric ambulatory settings. However, all settings featured substantial variation across organizations. Although maturity scores were strongly correlated with perceived level of 4Ms reach (% of patients receiving 4Ms care), small sample sizes precluded robust assessment of correlation with investment in organizational capabilities related to leadership, measurement, and other domains. These results demonstrate the feasibility of using a 4Ms implementation maturity model as the basis for a standardized approach to collecting comparable implementation progress data across health systems. Doing so at scale would enable valuable new insights into the complex work of 4Ms implementation as well as support robust evidence on the relationship between the level of 4Ms implementation and outcomes.