Feasibility of Implementing Patient Priorities Care for Older Adults with Multiple Chronic Conditions

Abstract

Older adults with multiple chronic conditions (MCCs) receive care that is fragmented and burdensome, lacks evidence, and most importantly is not focused on what matters most to them. An implementation feasibility study of Patient Priorities Care (PPC), a new approach to care that is based on health outcome goals and healthcare preferences, was conducted. This study took place at 1 primary care and 1 cardiology practice in Connecticut and involved 9 primary care providers (PCPs), 5 cardiologists, and 119 older adults with MCCs. PPC was implemented using methods based on a practice change framework and continuous plan‐do‐study‐act (PDSA) cycles. Core elements included leadership support, clinical champions, priorities facilitators, training, electronic health record (EHR) support, workflow development and continuous modification, and collaborative learning. PPC processes for clinic workflow and decision‐making were developed, and clinicians were trained. After 10 months, 119 older adults enrolled and had priorities identified; 92 (77%) returned to their PCP after priorities identification. In 56 (46%) of these visits, clinicians documented patient priorities discussions. Workflow challenges identified and solved included patient enrollment lags, EHR documentation of priorities discussions, and interprofessional communication. Time for clinicians to provide PPC remains a challenge, as does decision‐making, including clinicians' perceptions that they are already doing so; clinicians' concerns about guidelines, metrics, and unrealistic priorities; and differences between PCPs and patients and between PCPs and cardiologists about treatment decisions. PDSA cycles and continuing collaborative learning with national experts and peers are taking place to address workflow and clinical decision‐making challenges. Translating disease‐based to priorities‐aligned decision‐making appears challenging but feasible to implement in a clinical setting.

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

“…The tools and clinical scenarios are illustrative and not meant to be an exhaustive listing. Components of the Actions were applied in a pilot project during which they were modified based on clinician feedback and experience . The work group provided iterative feedback during the development of the Framework and voted unanimous agreement on the Actions, Action Steps, and final version of the article.…”

“…© 2018, The American Geriatrics Society. 32 variability. 35,36 Furthermore, decisions based on patients' healthcare preferences improve adherence.…”

“…Reproduced with permission from the Journal of the American Geriatrics Society . © 2018, The American Geriatrics Society …”

Putting Goal‐Oriented Patient Care Into Practice

“…This approach has inherent value because it engages patients, establishes personal goals, and sets targets for patients and clinicians to plan a course of action and measure success. Some notable efforts to integrate patient goals into healthcare include Patient Priority Care as well as integration of goals into the care of diseases, such as dementia and diabetes . In this article, we describe a practical approach to goal setting and measurement.…”

Paint by Numbers

“…W ith recent articles and an editorial, the Journal of the American Geriatrics Society has taken the initiative to propose a revision in the way medical care is provided to older adults with multimorbidity to provide an increased focus on patient-centered care (PCC). [1][2][3][4] We encourage further submissions on this topic, particularly clinical investigation studies. In this article, we assert that the complexity of our current menu-driven care for older persons with multimorbidity can undermine PCC and must be revised.…”