Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

Key Points Question What are the common goals and health care preferences of older adults with multiple health conditions? Findings In this cross-sectional study, 163 older adults reported 459 goals, most commonly encompassing activities with family and friends (24.2%), shopping (6.1%), exercising (4.6%), and living independently (4.4%). Medications most commonly cited as helpful were nonopioid pain medications (65.5% of users), sleep medications (52.9% of users), and inhalants (42.2% of users), whereas statins (25.8% of users) and antidepressants (32.5% of users) were the most commonly reported bothersome medications. Meaning Participants identified realistic and doable goals and health care preferences; this information can inform decision-making.

OBJECTIVES Patient Health Priorities Identification (PHPI) is a values‐based process in which trained facilitators assist older adults with multiple chronic conditions identify their health priorities. The purpose of this study was to evaluate patients’ perceptions of PHPI. DESIGN Qualitative study using thematic analysis. SETTING In‐depth semistructured telephone and in‐person interviews. PARTICIPANTS Twenty‐two older adults who participated in the PHPI process. MEASUREMENTS Open‐ended questions about patient perceptions of the PHPI process, perceived benefits of the process, enablers and barriers to PHPI, and recommendations for process enhancement. RESULTS Patient interviews ranged from 9 to 63 minutes (median = 20 min; interquartile range = 15–26). The mean age was 80 years (standard deviation = 7.96), 64% were female, and all patients identified themselves as white. Of the sample, 73% reported no caregiver involvement in their healthcare; 36% lived alone. Most patients felt able to complete the PHPI process with ease. Perceived benefits included increased knowledge and insight into disease processes and treatment options, patient activation, and enhanced communication with family and clinicians. Patients identified several factors that were both enablers and barriers to PHPI including facilitator characteristics, patient demographic and clinical characteristics, social support, relationships between the patient and their primary care provider, and the changing health priorities of the patient. Recommendations for process enhancement included more frequent and flexible facilitator contacts, selection of patients for participation based on specific patient characteristics, clarification of process aims and expectations, involvement of family, written reminders of established health priorities, short duration between facilitation and primary care provider follow‐up, and the inclusion of health‐related tasks in facilitation visits. CONCLUSIONS Patients found the PHPI process valuable in identifying actionable health priorities and healthcare goals leading to enhanced knowledge, activation, and communication regarding their treatment options and preferences. PHPI may be useful for aligning the healthcare that patients receive with their values‐based priorities.

In the United States, older adults account for a significant proportion of hospitalizations, and a subset become hospital-dependent, for reasons that are unclear. We conducted a qualitative study to explore these individuals' perspectives on their need for hospitalizations. Twenty patients hospitalized at an academic medical center underwent semistructured qualitative interviews. Criteria for selection included age 65 and older, at least three hospitalizations over six months, admission to the medical service at the time of the study, did not meet criteria for chronic critical illness, was not comfort measures only, and did not have a conservator. Interviews were audiotaped, transcribed, and inductively analyzed. The major themes derived were the necessity and inevitability of hospitalizations ("You have to bring me in here"), feeling safe in the hospital ("It makes me feel more secure"), patients hospitalized despite having outside medical and social support ("I have everything"), and inadequate goals-of-care discussions ("It just doesn't occur to me"). Results suggested that candid discussions about health trajectories are needed to ensure hospitalization is consistent with the patient's realistic health priorities. Journal of Hospital Medicine 2017;12:450-453.

Clinicians viewed the PPC approach as beneficial to their patients and themselves and identified challenges to implementation. This information will be critical to developing individualized implementation strategies to ensure optimal effectiveness in practices with varying workflows, payment structures, and populations served.