How My Health Checklist Changes the Conversation for Rural Community Health Workers and the Older Adults in their Care

Community health works (CHWs) in rural communities across the country listen to patients and advocate for their needs in conversations with providers and caregivers. They have explored ways to use an age-friendly resource, My Health Checklist, as part of this work. Designed specifically for older adults, the checklist helps them reflect on their health, identify what’s going well, and prioritize the questions and concerns that matter most. For CHWs and providers, it becomes a practical tool to make appointments more efficient, effective, and centered on the older adult.

My Health Checklist is grounded in the 4Ms Framework: What Matters, Medication, Mentation, and Mobility. The 4Ms are a set of four evidence-based elements of high-quality care for older adults. They are designed to be incorporated into existing care — many organizations find that they already provide care aligned with one or more of the 4Ms — to support reliable, equitable, age-friendly care.

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As part of this work, 15 rural CHWs and CHW trainers affiliated with the National Rural Health Association (NRHA) have been using My Health Checklist through a community of practice, hosted by NRHA and IHI, with support provided by AARP.

Here, the CHWs share learnings and takeaways about how My Health Checklist changes the conversation: 

• The checklist streamlines visits with the doctor. It provides focus, giving a framework for more directed conversations that are more productive. It’s not a script, but guidance. (USA Health Mitchell Cancer Institute)
• Ultimately, decisions really happen at home — they’re made by the older adult and caregiver, often in the car after the clinic visit, based on what matters to them. The checklist gives everyone involved the opportunity to really understand what the older adult wants. (USA Health Mitchell Cancer Institute)
• The checklist refocuses conversations from just clinical matters to what matters to the older adult. It provides better understanding of what influences care at home. For providers and CHWs, the checklist takes them out of a clinically-focused conversation, and helps them talk about what matters from the older adult’s perspective. For example, instead of talking about symptoms, they might switch to everyday language about what is happening at home. (National Rural Health Association)
• One team is starting to work closer with the primary care clinic and integrating the 4Ms principles and checklist into their way of communicating and their workflows. The physicians appreciate the checklist as a practical tool to guide these conversations to what people want (Hudson Hospital and Clinic)

The experiences of these rural CHWs show that My Health Checklist is more than a guide — it’s a catalyst for patient‑centered care. By amplifying the voices of older adults, supporting caregivers, and equipping providers with practical prompts, the checklist helps make every health care conversation count. In rural communities, where CHWs are trusted advocates and resources are often limited, this tool strengthens the connection between older adults and care teams. As the Age‑Friendly Health Systems movement continues to grow, My Health Checklist offers a simple yet powerful way to ensure that what matters most to older adults is always at the center of care.

Patty Webster, MPH, is an Improvement Advisor and Faculty at the Institute for Healthcare Improvement. Lynn Mertz, PhD, is Senior Strategic Policy Advisor at AARP. Cayla Saret, MPH, is a Senior Managing Editor at IHI.

Photo by Centre for Ageing Better on Unsplash.

You may also be interested in:

• Ideas for Sharing My Health Checklist with Older Adults and Those Who Support Them
• My Health Checklist, developed by IHI with support from The John A. Hartford Foundation
• Videos and resources from AARP about shared decision making with My Health Checklist
• Nine Opportunities to Advance Patient-Centered Care with My Health Checklist