In 2014, clinicians, patients, caregivers, health system leaders, payers, and funders from across the country came together to identify the key problems facing older adults with multiple chronic conditions.
to propose feasible and effective strategies for improving their care.
That effort, supported jointly by The John A. Hartford Foundation and Patient-Centered Outcomes Research Institute, consisted of workgroups and advisory panels charged with developing core elements for patients, caregivers, and clinicians to design aligned and goals-directed care.
Those core elements were:
Patients identify their health outcome goals and care preferences (collectively referred to as health priorities) with the help of a trained and skilled member of their healthcare team.
Primary and specialty clinicians align decision-making and care with patients’ health goals and preferences.
In 2015, some of the experts involved in the development of Patient Priorities Care launched the pilot phase of the project.
They spent a year developing and implementing patient and clinical training, building relationships with the participating health system, and creating the steps to incorporate Patient Priorities Care into practice.
The pilot, with the assistance of a few hundred older adults with multiple chronic conditions, nine primary care ProHealth clinicians, five cardiologists from ProHealth’s partner practice, and two trained health priorities facilitators, tested more effective and feasible ways to identify and transmit patients’ priorities, help clinicians translate these priorities into treatment options, and incorporate these changes into the busy clinical workflow through health information technology and clinical communication methods. The pilot compared the care of patients who did, and did not, participate in Patient Priorities Care to understand its impact on patient- and clinician-reported outcomes, healthcare burden, and healthcare utilization in a real-world healthcare environment.
To learn more about the Patient Priorities Care pilot, view the video here.
This phase of the project is funded by The John A. Hartford Foundation, Patient-Centered Outcomes Research Institute, the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation.
To ensure Patient Priorities Care achieves its aim of care that is consistent with what matters most to patients, it’s important to address how to incorporate it successfully into clinical practice. Patient Priorities Care developed a research agenda co-designed with patients and caregivers. In 2016, Patient Priorities Care partnered with the American College of Cardiology’s Geriatric Council and Patient & Family Centered Care Partners, Inc. to convene a large conference of stakeholders.
In 2017, Patient Priorities Care partnered with surgeons who are involved in the Coalition for Quality in Geriatric Surgery to further refine a research agenda that will apply to many specialties. Findings available here.
In 2018 the pilot study was completed with 350+ total patients participating. 5 publications were either published or are in progress as a result of the findings. Other products from this pilot include tools and guidelines for patients, caregivers, clinicians, and health systems to use to participate in the Patient Priorities Care approach.
The Scaling and Dissemination phase of the Patient Priorities Care project has begun with support from The John A. Hartford Foundation, Gordon and Betty Moore Foundation and the Robert Wood Johnson Foundation. This phase includes preparing technical assistance, products, and training that enables adoption of Patient Priorities Care, and collaborating with OurNotes on patients’ priorities directly informing patient and clinician interactions.
Patient Priorities Care developed an online curriculum in collaboration with the American College of Physicians. These modules are based on real-life encounters between patients and clinicians and are designed to impart the knowledge and skills needed to participate in this approach to decision-making and care. The curriculum provides web-based teaching, scripts, and patient scenarios across three modules: One module prepares members of the health care team to identify patient’s health priorities and the other two modules address challenges and strategies for implementing the approach. To accompany this curriculum launch a whiteboard explainer video was developed and can be found here.
Findings and measures from the PPC pilot at ProHealth Physicians were published by JAMA Internal Medicine: Association of Patient Priorities-Aligned Decision-Making With Patient Outcomes an Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Condition. This nonrandomized clinical trial found that participants had a greater reduction in treatment burden, more medications stopped, and fewer self-management/diagnostic tests added.
The Yale Patient Priorities Care team has been working with Cleveland Clinic to implement and evaluate the approach – made possible by funding from The Donaghue Foundation. The Cleveland Clinic implementation is being led by Dr. Ardeshir Hashmi.
The Michael E. DeBakey VA Medical Center in Houston, TX continues to implement Patient Priorities Care in their geriatric primary care outpatient clinic under the leadership of Drs. Aanand Naik and Angela Catic. In 2020 the clinic used the Patient Priorities Care approach to satisfy the Matters Most component of the 4Ms framework for Age Friendly Health Systems.
The University of North Carolina, under the leadership of Dr. Crystal Wiley Cené, received a grant from the National Institute on Aging to replicate and evaluate Patient Priorities Care in practices in the rural South.