Improving Primary Care Fall Risk Management: Adoption of Practice Changes After a Geriatric Mini-Fellowship

Facilitators and Barriers to Implementing the 4Ms Framework of Age-Friendly Health Systems: A Scoping Review

“…These findings were consistent with previous research [4] that implementation success required redesigning the healthcare system infrastructure along with needed clinical education and support [4] We also identified five barrier themes: (1) patients unable to actively participate in agefriendly care; (2) lack of infrastructure readiness to embrace the 4Ms Framework in clinical practice; (3) lack of clinicians' buy-in, as the most frequently mentioned barrier theme; (4) challenges in incorporating the 4Ms components in clinical practice; and (5) lack of clinician awareness. Our findings were consistent with previous interview studies [4] that identified the common barriers to implementing the IHI's 4Ms Framework as mostly related to clinicians' attitudes toward the benefits of adopting the 4Ms Framework (i.e., disengaged physicians) [4] In summary, our findings revealed many significant system factors (e.g., infrastructure readiness) that may hinder or support the implementation of the 4Ms Framework of Age-Friendly Health Systems [4,[13][14][15][16][17][18][21][22][23][24][25][26][27][28][29][30]. As an example, a recent review [33] around the implementation of the streamlining framework (for streamlining cancer multidisciplinary meetings) in the United Kingdom's national health system identified similar system issues.…”

“…In summary, our findings revealed many significant system factors (e.g., infrastructure readiness) that may hinder or support the implementation of the 4Ms Framework of Age-Friendly Health Systems [ 4 , 13 , 14 , 15 , 16 , 17 , 18 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. As an example, a recent review [ 33 ] around the implementation of the streamlining framework (for streamlining cancer multidisciplinary meetings) in the United Kingdom’s national health system identified similar system issues.…”

“…The findings of this scoping review could be translated into a facilitator and barrier checklist or a “reality-check” measure to monitor the journey of embracing the 4Ms Framework in outpatient or inpatient clinical settings. Strategies may be developed to address the barriers and leverage those facilitators unique to each clinical setting (e.g., its infrastructure readiness [ 4 , 13 , 15 , 16 , 18 , 25 , 26 , 27 , 28 ], clinical practice and staffing patterns [ 14 , 16 , 17 , 18 , 21 , 23 , 24 , 25 , 27 , 28 , 29 ]). Clinicians’ buy-in is another system improvement aspect that desires health system executives’ and administrators’ attention before implementing the 4Ms Framework of Age-Friendly Health Systems [ 4 , 13 , 18 , 22 , 23 , 25 , 28 , 30 ].…”

“…Cognitive screening [20] Aligning the health system's mission with the 4Ms Framework [4,18] • Health system climate readiness [18] • Alignment with clinics'/health systems' purpose in improving health [18] • Leadership, clinicians, and staff buy-in [4,18] Infrastructurereadiness to embrace the 4MsFramework [4,13,15,16,18,[25][26][27][28] •…”