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Implementing the 4M's in Rural Public Health
Journal article   Peer reviewed

Implementing the 4M's in Rural Public Health

Betty Mallen and Harleah G. Buck
Public health Nursing
02/20/2026
DOI: 10.1111/phn.70092
PMID: 41717982

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Abstract

Background Local public health departments (LHD) geographic distribution and scope of practice result in them as a primary source of care for rural older adults. The 4M's framework (What Matters, Medications, Mentation, Mobility) was developed to assess their needs. Public health is a good fit for implementing the 4M's framework. Purpose Phase 1) develop and implement a quality improvement project; Phase 2) adapt the project as needed and measure implementation outcomes (percentage of older adults assessed using the 4Ms; continued agency funding after project end) Methods The project utilized the Institute for Healthcare Improvement Plan-Do-Study-Act (PDSA) process to design and measure change. Seven PDSA cycles were conducted over a seven-month period at LHD clinics. Findings 285 participants accessed a clinic with 80 participants completing the 4M's assessment tool for a 28% completion rate. Leadership identified four existing funding sources to reallocate and five potential new grants to sustain the project. Discussion Utilizing LHDs is an innovative approach for 4M's implementation. Obtaining data provides valuable information on what is important to older adults. Expansion of the 4M's to other programs, connecting older adults to resources, and tying results to patient-centered outcomes will be important next steps.
 active aging age friendly aging in place gerontologic or community health nursing healthy aging

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