Addressing What Matters: A Pilot Study and Mixed Methods Evaluation of Patient Priorities Care in Four Clinical Settings

Abstract

Background

Older adults with multiple chronic conditions face significant challenges with their health. Patient Priorities Care (PPC) is an Age-Friendly approach that explores ‘what matters’ by identifying values, care preferences, and health priorities, and aligning healthcare based on patients' health outcome goals.

Methods

Patient priorities care was implemented in four clinical settings (Hospital in Home, a transitional care case management program and in two embedded clinics within specialty care settings) within a large academically affiliated Veteran Affairs hospital system. During the pilot phase, the structured PPC approach was deployed through multiple modalities within specialty practices, including telehealth, and descriptive measures were evaluated. During the evaluation phase, clinical process measures related to care alignment were assessed, and clinicians' perspectives on PPC were explored through semi-structured interviews, which were then coded and analyzed for themes.

Results

During the pilot phase, a total of 109 PPC conversations were conducted by telephone (48%), video (35%) and in-person (17%) across the four clinical settings. Participants were on average 80 ± 9 years old, white (89%), and male (94%). Multimorbidity (17 ± 8 chronic conditions per patient), cognitive impairment (39% of participants), and polypharmacy (15 ± 7 prescriptions per patient) were prevalent. During the evaluation phase, a total of 46 documented PPC conversations were reviewed. Clarifying preferences for life-sustaining treatment, modifying medications, and ordering durable medical equipment were the most common care alignment outcomes resulting from health priorities identification. Nine semi-structured interviews were conducted with clinicians responsible for continuing care alignment, and seven emergent themes were described, highlighting perceived barriers and promoters to utilizing the PPC framework.

Conclusion

PPC is an Age-Friendly approach to addressing ‘what matters’ that is feasible to implement in various clinical settings and through multiple modalities, including telehealth. Continuing to expand the delivery of conversations about ‘what matters’ is essential for developing and scaling Age-Friendly care.