Evaluating the relationship between facility Age‐Friendly recognition and subsequent facility‐free days in older Veterans

Abstract

AbstractBackgroundThousands of health systems have been recognized as “Age‐Friendly” for implementing geriatric care practices aligned with the “4Ms” (What Matters, Medication, Mentation, and Mobility). However, the effect of Age‐Friendly recognition on patient outcomes is largely unknown. We sought to identify this effect in the Veterans Health Administration (VHA)—one of the largest Age‐Friendly integrated health systems in the United States.MethodsThere were 50 VA medical centers (VAMCs) recognized as Age‐Friendly by December 2021. We used a time‐event difference‐in‐difference analysis to identify the association of a VAMC's recognition as Age‐Friendly on the change in facility‐free days (days outside the hospital or nursing home) among Veterans treated at that facility. We also evaluated this association in three subgroups: Veterans at particularly high risk of nursing home entry, Veterans who lived within 10 miles of a medical center, and facilities that had reached Level 2 Age‐Friendly recognition. We also evaluated individual components of the endpoint in terms of change in hospital and nursing home days separately.ResultsWe found Age‐Friendly recognition was associated with small statistically significant improvements in facility‐free days (0.2% on a base of 97% facility‐free days on average per year, or an additional 0.73 days per year on a base of 354 days). There were no differences in any subgroup, or any individual component of the endpoint across all groups.ConclusionsAt the individual level, an increase of 0.2% in facility‐free days is a weak effect. However, sites were early in implementation, and facility‐free days may not be a responsive outcome measure. However, across an entire population, small changes in facility‐free days may accrue large cost savings. Future evaluations should consider a broader variety of process and outcome measures.