{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:03:01Z","timestamp":1789794181561,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["EBP 22\u2013105"],"award-info":[{"award-number":["EBP 22\u2013105"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Implementation of Age\u2010Friendly Health Systems (AFHS)\u2014an initiative promoting healthcare safety and quality for older adults\u2014is particularly important in inpatient settings, where older adults are at increased risk of hospital\u2010associated complications and disability. The Veterans Health Administration (VHA) is the largest integrated AFHS in the country, but AFHS inpatient implementation within VHA is heterogeneous. To support broader implementation, we selected high\u2010performing VHA Medical Centers (VAMCs) to examine factors contributing to their AFHS implementation success and the remaining challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We selected three VAMCs with a high proportion of patients who had undergone complete AFHS 4Ms assessments (What Matters, Medications, Mentation, and Mobility) in at least one inpatient unit, as documented in the electronic health record (i.e., \u201chigh performers\u201d). We conducted 11 semi\u2010structured interviews with leaders and frontline staff involved in AFHS implementation, guided by the integrated\u2010Promoting Action on Research Implementation in Health Services (i\u2010PARIHS) framework to elicit information on implementation strategies, facilitators, and barriers. Interviews were analyzed using template analysis, blending deductive codes aligned with i\u2010PARHIS and inductive codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across I\u2010PARIHS domains, we identified facilitators and barriers to implementation. Facilitators included: flexibility to customize implementation to local needs; teams exhibiting interdisciplinary respect, role clarity, and passion for geriatric care; alignment of AFHS with existing patient\u2010centered care values; leadership support alongside adequate resources; and champions who led education efforts and rallied support by demonstrating impact. Barriers included: challenges meaningfully eliciting and integrating \u201cWhat Matters\u201d into inpatient care; difficulty identifying short\u2010term patient impact; discipline\u2010specific staffing issues; and lack of AFHS inpatient teams to consult about implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Successful AFHS inpatient implementation is affected by several interrelated domains. Learning from facilitators and barriers at high\u2010performing VHA sites may help VHA and non\u2010VHA health systems strengthen and tailor AFHS efforts to ensure hospitalized older adults receive age\u2010friendly care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70723","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T04:54:41Z","timestamp":1789793681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inpatient Implementation of Age\u2010Friendly Health Systems: Qualitative Insights From Three Veterans Affairs Medical Centers"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6149-0950","authenticated-orcid":false,"given":"Brooke V.","family":"Jespersen","sequence":"first","affiliation":[{"name":"Center to Improve Veteran Involvement in Care (CIVIC) VA Portland Health Care System  Portland Oregon USA"},{"name":"School of Public Health Oregon Health &amp; Science University\u2010Portland State University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Good","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany L.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3008-1230","authenticated-orcid":false,"given":"Samantha","family":"Solimeo","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"Transformative Health Systems Research to Improve Veteran Equity and Independence Center of Innovation (THRIVE), Providence VA Healthcare System  Providence Rhode Island USA"},{"name":"Department of Medicine Warren Alpert Medical School of Brown University  Providence Rhode Island USA"},{"name":"Center for Gerontology and Healthcare Research Brown School of Public Health  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scotte","family":"Hartronft","sequence":"additional","affiliation":[{"name":"Veterans Health Administration Office of Geriatrics and Extended Care  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A.","family":"Mengeling","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CPIC \u2013 VA QUERI Center","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1832-7901","authenticated-orcid":false,"given":"Heather","family":"Davila","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"VHA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15076"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2017.05.005"},{"key":"e_1_2_11_4_1","first-page":"7","article-title":"Evidence for the 4Ms: Interactions and Outcomes Across the Care Continuum","volume":"33","author":"Mate K. 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