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Background <p>To address gaps in geriatric care, the Geriatrics Workforce Enhancement Program (GWEP) implemented a multi‑year educational and systems-level intervention aligned with the Age-Friendly Health System 4Ms framework across eight diverse primary care sites. This study examined the association between the intervention and changes in geriatrics screening practices and care processes for older adult patients.</p> Methods <p>In collaboration with social workers and health system educators, the GWEP team developed and implemented seven structured educational sessions for primary care teams, in addition to integrating geriatric consultants into primary care clinics and electronic medical record enhancements. Topics of the educational sessions, based on the 4Ms framework, included polypharmacy, advance care planning, and Medicare Annual Wellness Visits, with accompanying, distinct changes to workflow and care processes. Unadjusted pre–post comparisons were conducted using chi-square tests and Generalized Estimating Equation logistic regression models adjusted for covariates were used to assess screening outcomes of interest. Changes in fall risk screening rates across study phases were analyzed using a piecewise linear mixed-effects regression model.</p> Results <p>Fifty-six primary care providers, along with 180 medical residents under their supervision, cared for 8,818 older adults throughout the study period. Adjusted analyses demonstrated improvements in dementia (odds ratio 1.27, 95%CI: 0.98–1.63) and fall risk screening (odds ratio 1.40, 95%CI: 1.00–1.95) following implementation of the intervention, with variability across sites and the largest gains observed in two clinics with stronger systems integration. Fall risk screening demonstrated the strongest improvement following intervention implementation (+ 0.64% per month, <i>p</i> &lt; 0.001). Screening for opioid use (odds ratio 0.57, 95%CI: 0.36–0.90) and documentation of advance care planning (odds ratio 0.85, 95%CI: 0.80–0.91) significantly declined over time, coinciding with the COVID-19 pandemic. No overall significant changes were observed in hypertension control or high-risk medication measures, despite site-level variation.</p> Conclusions <p>Clinics receiving additional workflow support or enhanced collaboration with geriatric consultants showed the most robust improvements. These findings highlight the importance of combining interprofessional education with team‑based infrastructure and community partnerships to strengthen geriatric care in primary care settings, while highlighting the vulnerability of complex geriatric processes during periods of healthcare disruption.</p>

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Multi-site evaluation of an interprofessional education and systems intervention to improve geriatric screening in primary care

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Debra K. Litzelman,
  • Julie Vannerson,
  • Emilie L. Garrison,
  • Yan Tong,
  • Qing Tang,
  • Melissa R. Thomas,
  • Dawn Butler

摘要

Background

To address gaps in geriatric care, the Geriatrics Workforce Enhancement Program (GWEP) implemented a multi‑year educational and systems-level intervention aligned with the Age-Friendly Health System 4Ms framework across eight diverse primary care sites. This study examined the association between the intervention and changes in geriatrics screening practices and care processes for older adult patients.

Methods

In collaboration with social workers and health system educators, the GWEP team developed and implemented seven structured educational sessions for primary care teams, in addition to integrating geriatric consultants into primary care clinics and electronic medical record enhancements. Topics of the educational sessions, based on the 4Ms framework, included polypharmacy, advance care planning, and Medicare Annual Wellness Visits, with accompanying, distinct changes to workflow and care processes. Unadjusted pre–post comparisons were conducted using chi-square tests and Generalized Estimating Equation logistic regression models adjusted for covariates were used to assess screening outcomes of interest. Changes in fall risk screening rates across study phases were analyzed using a piecewise linear mixed-effects regression model.

Results

Fifty-six primary care providers, along with 180 medical residents under their supervision, cared for 8,818 older adults throughout the study period. Adjusted analyses demonstrated improvements in dementia (odds ratio 1.27, 95%CI: 0.98–1.63) and fall risk screening (odds ratio 1.40, 95%CI: 1.00–1.95) following implementation of the intervention, with variability across sites and the largest gains observed in two clinics with stronger systems integration. Fall risk screening demonstrated the strongest improvement following intervention implementation (+ 0.64% per month, p < 0.001). Screening for opioid use (odds ratio 0.57, 95%CI: 0.36–0.90) and documentation of advance care planning (odds ratio 0.85, 95%CI: 0.80–0.91) significantly declined over time, coinciding with the COVID-19 pandemic. No overall significant changes were observed in hypertension control or high-risk medication measures, despite site-level variation.

Conclusions

Clinics receiving additional workflow support or enhanced collaboration with geriatric consultants showed the most robust improvements. These findings highlight the importance of combining interprofessional education with team‑based infrastructure and community partnerships to strengthen geriatric care in primary care settings, while highlighting the vulnerability of complex geriatric processes during periods of healthcare disruption.