Collaborating toward equity in Pennsylvania: The Age-Friendly Care,PA project

Objective

To collaboratively implement the age-friendly health systems framework, known as the 4Ms: What Matters, Medication, Mentation, and Mobility, at The Primary Health Network (PHN), a federally qualified health center.

Data Sources

Data were collected from PHN electronic medical records (EMRs) for individuals over age 65 from December 30, 2019 to December 24, 2021 and from Project ECHO© attendance and evaluation surveys.

Study Design

The telementoring educational program, Project ECHO©, was used to engage PHN health care professionals working in rural areas of Pennsylvania to incorporate the 4Ms into their practice starting with the annual wellness visit (AWV). Project ECHO© was launched at three primary care sites. After 18 months, it was then disseminated to an additional 18 sites creating pilot and comparison groups. Outcomes included codesigned patient process metrics using EMR data and project ECHO© participant data.

Data Collection Methods

EMR data were generated by system reports created by PHN's quality assurance program manager. Project ECHO© data were collected and managed using REDCap electronic data capture tools. Outcomes were aggregated, analyzed for trends over time, and compared between groups.

Principal Findings

All nine process outcomes increased from baseline to follow-up at the three initial sites, ranging from 4% to 43% g. At year two, the three initial sites had higher rates on AWVs (pilot 24%, comparison 12%; p < 0.0001), Advance Care Planning (New on file, pilot 8%, comparison 2%; Discussed with patient, pilot 18%, comparison 13%; Patient declined, pilot 0%, comparison 0%; p = 0.0001), Dementia Screening (pilot 24%, comparison 12%; p < 0.0001), Fall Risk Management (pilot 43%, comparison 10%; p < 0.0001), and Mobility Goal (pilot 19%, comparison 9%; p < 0.0001); and lower rates on High-Risk Medication Elimination (pilot 54%, comparison, 63%, p < 0.02).

Conclusions

Access to high-quality geriatric care for rural older adults can be improved by increasing health care professionals' knowledge of the 4Ms, beginning with its incorporation into the AWV.     

Perspective: Implementation of Nursing Language in Long-Term Care and Nursing Education

PURPOSE.  This article describes one nurse's experiences of returning to school after a 10-year absence, her introduction to nursing theory and terminology, and her subsequent implementation of nursing language in a long-term care setting and later experiences in teaching nursing language to students.
DATA SOURCES.  A 21-year career as a long-term care nurse coincided with the evolution of the new organization North American Nursing Diagnosis Association International, and she found herself in a position to implement nursing diagnosis in the long-term care setting. Practice experiences and pertinent nursing references and resources were used in clinical implementation and in teaching nursing students.
DATA SYNTHESIS.  The author reviewed the implementation and teaching of nursing language from a personal historical perspective.
CONCLUSIONS AND IMPLICATIONS FOR PRACTICE.  The author's experiences and perspectives on implementation of nursing language in clinical practice and in teaching provide information and a perspective for nurses and students involved in these processes.     

Linking Classroom Learning to the Community Through Service Learning

Service learning is valued as a means of providing education to students and service to the community. The purpose of this article is to describe the incorporation of service learning in an undergraduate baccalaureate level Gerontology nursing course. Details of the service learning experience, community agency partnership, the students' reflections, evaluations from both the students and community agency staff, and faculty challenges are presented. This information may be useful to others who are considering service learning as a strategy for educating students while providing service to the community.