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{ "pk": 18088, "title": "Usability of the 4Ms Worksheet in the Emergency Department for Older Patients: A Qualitative Study", "subtitle": null, "abstract": "Introduction:\n Older adults often have multiple comorbidities; therefore, they are at high risk for adverse events after discharge. The 4Ms framework—what matters, medications, mentation, mobility—has been used in acute and ambulatory care settings to identify risk factors for adverse events in older adults, although it has not been used in the emergency department (ED).Weaimed to determine whether 1) use of the 4Ms worksheet would help emergency clinicians understand older adult patients’ goals of care and 2) use of the worksheet was feasible in the ED.\nMethods: \nWe conducted a qualitative, descriptive study among patients aged ≥60 years and emergency clinicians from January–June 2022. Patients were asked to fill out a 4Ms worksheet; following this, semi-structured interviews were conducted with patients and clinicians separately. We analysed data to create codes, which were divided into categories and sub-categories.\nResults:\n A total of 20 older patients and 19 emergency clinicians were interviewed. We identified two categories based on our aims: understanding patient goals of care (sub-categories: clinician/ patient concordance; understanding underlying goals of care; underlying goals of care discrepancy) and use of 4Ms Worksheet (sub-categories: worksheet to discussion discrepancy; challenges using worksheet; challenge completing worksheet before discharge). Rates of concordance between patient and clinician on main concern/goal of care and underlying goals of care were 82.4% and 15.4%, respectively.\nConclusion: \nWe found that most patients and emergency clinicians agreed on the main goal of care, although clinicians often failed to elicit patients’ underlying goal(s) of care. Additionally, many patients preferred to have the interviewer fill out the worksheet for them. There was often discrepancy between what was written and what was discussed with the interviewer. More research is needed to determine the best way to integrate the 4Ms framework within emergency care.", "language": null, "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Geriatrics" }, { "word": "goals of care" }, { "word": "Age-friendly health system" } ], "section": "Geriatrics", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4nd2734n", "frozenauthors": [ { "first_name": "McKenzie", "middle_name": "A.", "last_name": "McKnight", "name_suffix": "", "institution": "University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Melissa", "middle_name": "K.", "last_name": "Sheber", "name_suffix": "", "institution": "University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Daniel", "middle_name": "J.", "last_name": "Liebzeit", "name_suffix": "", "institution": "University of Iowa, College of Nursing, Iowa City, Iowa", "department": "None" }, { "first_name": "Aaron", "middle_name": "T.", "last_name": "Seaman", "name_suffix": "", "institution": "University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Erica", "middle_name": "K.", "last_name": "Husser", "name_suffix": "", "institution": "Penn State University, Ross and Carol Nese College of Nursing, University Park, Pennsylvania", "department": "None" }, { "first_name": "Harleah", "middle_name": "G.", "last_name": "Buck", "name_suffix": "", "institution": "University of Iowa, College of Nursing, Iowa City, Iowa", "department": "None" }, { "first_name": "Heather", "middle_name": "S.", "last_name": "Reisinger", "name_suffix": "", "institution": "University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa", "department": "None" }, { "first_name": "Sangil", "middle_name": "", "last_name": "Lee", "name_suffix": "", "institution": "University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa; Department of Epidemiology, University of Iowa College of Public Health, Department of Emergency Medicine, Iowa City, Iowa", "department": "None" } ], "date_submitted": "2023-04-22T04:23:02+03:00", "date_accepted": null, "date_published": "2024-01-25T18:37:00+03:00", "render_galley": { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18088/galley/9220/download/" }, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/18088/galley/9220/download/" } ] }