VA Healthcare-VISN 4
Safer Aging through Geriatrics-Informed Evidence-based practices (SAGE)
Members of the SAGE QUERI team shown in a meeting to discuss observations from visits to medical facilities in VISN4
More than four million Veterans are aged 65 and older. VISN 4 serves one of the oldest Veteran populations in the country: 62% of approximately 275,000 Veterans in VISN 4 who use the VA for care are 65+.
To help VISN 4 medical centers and clinics improve care of older Veterans the “Safer Aging through Geriatrics-informed Evidence-based practices” (SAGE) will implement four evidence-based practices that can help catalyze a transition to practices for all older Veterans; and help VA facilities be the most effective in choosing and implementing practices that make measurable impacts on the health and well-being of older Veterans in their care.
Aligned with VA’s Whole Health program, the SAGE initiative is designed to improve clinical outcomes for older Veterans and to provide interventions and innovations to help them age safely at home. All VISN 4 medical centers and community-based outpatient clinics are included, and the implementation of the SAGE practices will be modified based on the needs of the patient population at each facility.
Our overall goal in the VISN4 SAGE QUERI program is to reach as many older Veterans as possible who will benefit from these evidence-based practices, and we are measuring how effective these are in reducing the number of days older Veterans spend in the hospital or nursing home.
This means that we will maximize the reach of our interventions to as many eligible Veterans as possible, resulting in increased “facility-free days” (i.e., days alive and outside the hospital/nursing home) for individuals.
SAGE is led by researchers and implementation scientists from the VA Center for Health Equity Research and Promotion (CHERP) in Philadelphia and Pittsburgh and funded by VA QUERI (Quality Enhancement Research Initiative). SAGE partners include the VA Office of Geriatrics and Extended Care and the VA National Surgery Program, as well as non-VA organizations such as the Institute for Healthcare Improvement (IHI) and the John A. Hartford Foundation.
Evidenced-based practices (The Four M's)
SAGE evidence-based practices address specific areas where older adults are particularly vulnerable to harm. You can read more about how we will approach each these domains by following the links:
What Matters – “Surgical Pause”
Screens older Veterans at risk for poor postoperative outcomes and prompts a structured conversation to clarify patients’ expectations for surgery and recovery.
Medication – “EMPOWER”
Educates older Veterans and their caregivers about potentially high-risk medications and empowers Veterans to make changes aligned with their health goals.
Mentation – “TAP"
TAP is a home-based, tailored intervention that improves functional capabilities of Veterans with dementia and reduces caregiver burden.
Mobility – “CAPABLE”
Assess and modify the home environment to promote safe and independent living.
Over the next 5 years, lessons learned from VISN4 will be used to implement these practices VA-wide. Research has shown that geriatrics-informed care improves health and outcomes for individuals, and, most importantly, increases the number of days that older Veterans can age safely at home rather than in a hospital or nursing home. All VISN4 medical centers and community-based outpatient clinics are included, and the implementation of the SAGE practices will be modified based on the needs of the patient population at each facility.
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