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Using the Military Medical Acuity Model to guide patient care

Background and applications MAM is a patient-centered acuity system based on objective physiologic measures mined from the electronic health record (EHR). MAM translates existing data into recognizable patterns that can be displayed to the clinician. The MAM is designed for use throughout a facility, rather than on a specific unit or specialty area, and allows comparisons among units and facilities regardless of location. It’s intended to provide a common lens through which clinicians can view individual patients across multiple specialties. It can also be applied to specific requirements for resource planning and utilization within existing workflow patterns. MAM is an assessment tool developed by the author from existing literature. MAM mines existing EHR reporting tools and is easily incorporated into daily workflow. The model can also enhance interprofessional communication by generating a common operating picture of patient acuity. MAM framework The framework for the MAM includes four concepts from the American Association of Critical Care Nurses (AACN) Synergy Model for Patient Care: • complexity (the entanglement of two or more systems) • stability (the ability to maintain equilibrium) • vulnerability (susceptibility to stressors) • resiliency (the capacity to return to higher function after insult). The AACN Synergy Model recognizes that all patients have similar needs across the continuum from health to illness. In this model, complexity and stability identify the degree of physiologic dysfunction. Vulnerability and resiliency measure the patient’s ability to adapt to physiologic dysfunction and identifies the risk of future decline. In the MAM tool, these four concepts are measured by 17 individual objective parameters. The MAM values are based on a simple rubric: A normal score is zero, with any deviation from 1 to 3 for each measure depending on the variable and degree of dysfunction. All scores are positive, meaning that a higher score equals a higher acuity. In the MAM scoring methodology, the absence of a value results in a score of zero. The intent is to treat missing data the same whether the omission is a conscious decision or an error (such as a data query error). Multiple data sampling points over time help normalize the patient’s MAM score. The MAM is a multidisciplinary tool derived from evidence-based studies and various objective measures. The objective measures were selected because of their presence in more than one tool, or more than one evidence-based study in several different disciplines. Collection of these objective measures and physiologic parameters is nearly universal in inpatient facilities.