CHICAGO — The American College of Surgeons (ACS) has been awarded a grant from the Council of Medical Specialty Societies (CMSS), funded by The John A. Hartford Foundation, to help ambulatory surgery centers (ASCs) implement the “4Ms” framework of Age-Friendly Health Systems. The initiative aims to better track what matters most to older adult patients and improve their surgical outcomes and experience.
More than half of all operations in the U.S. are now performed in the outpatient setting, and patients aged 65 and older represent a significant and growing portion of those surgical cases. While ASCs offer efficiency and convenience, more efforts are needed to aid them in addressing the unique needs of older adults to ensure safe, high-quality care, and recovery.
The 4Ms framework—What Matters, Medication, Mentation, and Mobility—provides an evidence-based care model for older patients. With this funding, the ACS will develop a practical tool for surgical teams to identify patient goals, optimize medications, and assess cognitive function, and physical mobility before and after surgery. Additionally, a comprehensive implementation guide will be developed to help ASCs integrate the 4Ms into their routine workflows.
Why It Matters for Hospitals and Surgical Teams
For hospitals and ASCs, adopting the 4Ms is a proactive step toward improving quality and reducing costly complications. Research shows that implementing geriatric-focused protocols can significantly reduce postoperative length of stay and inpatient costs for frail patients. This new perioperative tool and implementation guide will provide actionable steps to extend this to the ambulatory setting, including:
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Workflow maps for incorporating 4M assessments into pre- and post-operative care.
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"Action plans" for responding to positive screens for cognitive decline or mobility issues.
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Tools to systematically collect patient-reported outcomes, giving surgeons and ASCs critical data to understand surgical efficacy and quality from the patient’s perspective.
By participating, ASCs can benchmark their performance and demonstrate a commitment to delivering age-friendly care.
Why It Matters for Patients and Families
For older adults and their caregivers, this initiative means receiving care that is aligned with their personal health goals. Instead of a one-size-fits-all approach, surgical teams will be equipped to understand what matters most to the patient. That could mean maintaining independence, managing a specific condition, or returning to a favorite activity. The focus on the 4Ms ensures that medication plans are safe, cognitive function is supported, and mobility is prioritized to help patients recover faster and get back to the kind of life they value.
“As the population ages, it is imperative we adapt our surgical care models to meet the specific needs of older adults,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care. “This grant from CMSS allows the ACS to take a leading role in making Age-Friendly care the standard in ambulatory surgery centers. By providing a practical, evidence-based guide, we can empower surgical teams to focus on what matters most to the patient, ultimately improving both their clinical outcomes and their overall experience.”
The perioperative tool and implementation guide will be developed in collaboration with subject matter experts and piloted at a limited number of partner sites before being made more broadly available. The project will leverage technology and existing electronic health record (EHR) systems to streamline data collection and ensure patient privacy is protected.
Learn more about quality improvement programs for older adult surgical patients such as the ACS Geriatric Surgery Verification program.
The Expanding Age-Friendly Approaches to Specialty Ambulatory Care project is supported by The John A. Hartford Foundation through a grant of $1,500,000 to the Council of Medical Specialty Societies. The John A. Hartford Foundation, based in New York City, is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the foundation has three areas of emphasis: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care.
