Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care

Abstract

BACKGROUND/OBJECTIVES Aligning healthcare decisions with patients’ priorities may improve care for older adults with multiple chronic conditions (MCCs). We conducted a pilot study to assess the feasibility of identifying patient priorities in routine geriatrics care and to compare clinicians’ recommendations for patients who did or did not have their priorities identified. DESIGN Retrospective chart review. SETTING Veterans Administration Medical Center Geriatrics Clinic. PARTICIPANTS Older adults with MCCs receiving Patient Priorities Care (PPC; n = 35) were matched with patients receiving usual care (UC; n = 35). Both PPC and UC patients were cared for by three primary care providers (PCPs) in an ambulatory geriatric clinic. INTERVENTION In the PPC group, a clinician facilitator met with each patient to identify their healthcare priorities and transmitted patients’ priorities in the electronic health record (EHR). Trained PCPs then sought to align healthcare decisions with patients’ priorities. In the UC group, patients received usual care from the same PCPs. MEASUREMENTS We matched patients by clinician seen, patient’s age, number of active conditions, medications, hospitalizations, functional status, and prior hospitalizations. EHRs were reviewed to identify care decisions including medications added or stopped, referrals and consults added or avoided, referrals to community services and supports, self‐management activities added or avoided, and total number of changes to care. Mean differences in recommended care between PPC and UC patients from the same PCPs were examined. RESULTS Clinician facilitators could identify patient priorities during routine clinic encounters. Compared with patients in the UC group, those in the PPC group had, on average, fewer medications added (P = .05), more referrals to community services and supports (P = .03), and more priorities‐aligned self‐management tasks added (P = .005). CONCLUSION These findings support the feasibility of identifying and documenting patient priorities during routine encounters. Results also suggest that clinicians use patient priorities in recommending care.

Use of the Patient-Identified Top Health Priority in Care Decision-making for Older Adults With Multiple Chronic Conditions

“…[1][2][3][4] PPC has been associated with a reduced treatment burden and increased preference-concordant care. 1,5 The goals of this cross-sectional study were (1) to determine the top health priority that patients most wanted to focus on to achieve their goals and (2) to consider how this priority addresses challenges while facilitating decision-making that aligns with patients' priorities. I want better control of my anxiety so that I can better control my blood pressure and maybe take less meds for blood pressure.…”

Better care for older Hispanics: Identifying priorities and harmonizing care

“…PPC is an evidence‐based approach that allows patients to reflect on and identify their healthcare values, or what matters most to them, and identify “the one thing” they want to address based on their healthcare preferences 13 . Studies have demonstrated that the PPC approach is feasible, resulted in less burdensome care, including fewer medications and referrals to specialists, 21 and helped clinicians recommend home and community services that were aligned with the patient's priorities 22 . However, these studies included few non‐White or Hispanic participants.…”

Measuring Adoption of Patient Priorities–Aligned Care Using Natural Language Processing of Electronic Health Records: Development and Validation of the Model

“…This study opens 3 new avenues for further investigation. By identifying PPC notes, we can longitudinally assess care for patients throughout VA facilities and understand changes in health care delivered after PPC encounters [6,21]. We can identify patterns and consistency in how social workers and other clinicians document patient priorities over the course of multiple interactions with patients [3].…”

“…With input from patients, caregivers, clinicians, health system leaders, payers, and health care design experts, we developed Patient Priorities Care (PPC), which involves identifying, documenting, and providing care consistent with patients' health priorities [4,5]. PPC is an intervention that aims to help clinicians provide health care to older patients with MCC that aligns with their priorities, which include their individual values (what matters most), desired outcome goals, and health care preferences [1][2][3][4][5][6].…”