FROM COMMUNITY TO CARE - CHWs Advancing Age-Friendly Health in FQHCs - Research Report

Sep 29, 2026

Project evidence outlines how Community Health Workers (CHWs) were integrated into Age-Friendly Health Systems (AFHS) in FQHCs using the 4Ms framework—What matters, Mentation, Medication, and Mobility. Twelve CHWs completed a 30-hour in-person geriatric care training, with pre/post surveys and Wilcoxon Signed-Rank Test evaluating knowledge change. Documentation and screening outcomes were analyzed from 55 EHR chart reviews (Feb–Apr 2025). Results show significant knowledge gains and near-universal Medication, Mobility, and What Matters documentation, with Mentation screening varying by condition.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Training goals and evaluation methods

Results

Knowledge change and documentation performance

Screening rates across 4Ms

Conclusion

Adoption strengths and improvement needs

1234 Innovation in Aging, 2025, Vol. 9, No. S2 Abstract citation ID: igaf122.4125 FROM COMMUNITY TO CARE: CHWS ADVANCING AGE-FRIENDLY HEALTH IN FQHCS Cherell Cottrell-Daniels1, Joycelyn Lawrence2, Kevin Espinoza3, Katherine Chung-Bridges1, Diego Shmuels4, Deborah Gracia4, and Sweta Tewary5, 1. Health Choice Network, Miami, Florida, United States, 2. Jessie Trice Community Health System, Miami, Florida, United States, 3. Health Choice Network, Inc., Miami, Florida, United States, 4. Borinquen Healthcare Center, Inc., Miami-Dade, Florida, United States, 5. Jessie Trice Community Health Center, Miami, Florida, United States Background: The growing older adult population in the U.S. has increased demand for health care professionals with specialized training in geriatrics. Geriatric Workforce Enhancement Programs (GWEPs) across the country are tasked with training Community Health Workers (CHWs) to meet this need. This project integrated CHWs into Age-Friendly Health Systems (AFHS) using 4Ms framework (What matters, Mentation, Medication, Mobility) . Goals included assessing changes in CHWs knowledge, intent to use training, and baseline geriatric screenings. Methods: Twelve CHWs completed a 30-hour in-person geriatric care training covering syndromes, community resources, patient-centered care, and the 4Ms of AFHS. Pre/post surveys captured demographics, satisfaction, and self-rated knowledge. The Wilcoxon Signed-Rank Test assessed changes in knowledge. CHWs documented 4Ms discussion with older adults (65+) using the electronic health record (EHR) unstructured notes section and spreadsheets. Data from 55 chart reviews (Feb-April 2025) were assessed for screening rates and documentation consistency. Results: CHWs were 73% female, 45% White, with an average age of 40 years. Pre-training, 36% rated their knowledge as moderate; post-training, 91% reported high knowledge and high likelihood of applying information. Knowledge gains were statistically significant (z = -2.23, p =.026) . CHWs documentation for Medication, Mobility, and What Matters was 100%; Mentation screening was 87% for depression, 31% for dementia, with full completion of all 4Ms in 31% of encounters. Conclusion: Findings suggest strong adoption of the 4Ms components, ease of documentation, with opportunities for improvement in dementia screenings and overall 4Ms completion. Strengthening EHR infrastructure is needed to support age-friendly care.

FAQs

What was the purpose of integrating CHWs into Age-Friendly Health Systems?

The project aimed to train CHWs to meet growing geriatric workforce needs and to assess changes in knowledge, training intent, and baseline geriatric screening outcomes using the 4Ms framework.

How was the geriatric training delivered and evaluated?

Twelve CHWs completed a 30-hour in-person geriatric care training. Pre/post surveys measured demographics, satisfaction, and self-rated knowledge, while a Wilcoxon Signed-Rank Test assessed knowledge changes.

What did the chart review analysis show about documentation and screening?

Across 55 chart reviews, CHWs documented Medication, Mobility, and What Matters at 100%. Mentation screening varied by condition (87% depression, 31% dementia), and full completion of all 4Ms occurred in 31% of encounters.

What improvements were recommended after the study findings?

The findings support strong adoption of 4Ms and ease of documentation, but highlight opportunities to improve dementia screening and overall 4Ms completion, with a need to strengthen EHR infrastructure to support age-friendly care.

Sep 29, 2026

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