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Frequently Asked Questions

Not finding the answer to your question? We’re happy to address any questions you have regarding Patient Priorities Care, just contact us.

About Patient Priorities Care

Patient Priorities Care (PPC) is an approach that aligns health care decision-making and care with patients’ own health priorities [i.e. the health outcome goals they most want to achieve given what they are willing and able to do to achieve them (their care preferences)]. This is particularly important for persons with multiple health conditions who face many tradeoffs in their decision making and care.

When patients have more than one ongoing health condition and see multiple clinicians, health care can get overwhelming and fragmented. The benefits and harms of many interventions are uncertain in the face of multiple chronic conditions and variable life circumstances. Persons with multiple conditions and complex life circumstances vary in the outcomes that matter most, particularly when faced with tradeoffs.

Knowing a patient’s health priorities allows all health professionals to partner with patients and care partners to align care recommendations with each patient’s most desired health and life goals based on what they are willing and able to do.

A patient’s priorities, or what matters most to them, is used to guide decisions about care in the face of uncertainty. Their priorities are the focus of communication, serial trials, and prioritizing decisions when multiple perspectives exist.

This approach helps patients be active partners in their health care decisions. Clear health priorities understood by patients, their care partners, and their clinicians reduces burdensome or unwanted care. Patient Priorities Care improves communications among patients, clinicians, and care partners by ensuring everyone is focused on the same outcomes.

PPC helps clinicians by providing a systematic way to care for complex patients and can help reduce unwanted utilization and increase patient satisfaction. For health systems and payors, it can optimize utilization and increase patient satisfaction.

While PPC is suitable for all patients, it can be especially beneficial for older adults who are:

  • Struggling to manage multiple conditions
  • Seeing multiple clinicians
  • Receiving conflicting recommendations
  • Overwhelmed by their current care regimen

It is also a helpful tool for clinicians who have complex, challenging patients.

A national team of clinicians, patients, caregivers, health system leaders, researchers and health policy experts developed this approach to align health care among clinicians with each patient’s own health priorities. It is continuously refined with input from users.

How Patient Priorities Care fits other approaches to decision making and care

PPC integrates decision-making and care across conditions and clinicians by tailoring care options to those consistent with each patient’s goals and health care preferences rather than treating each individual condition in isolation. Rather than being an end in and of itself, management of individual diseases is a means toward achieving patients’ goals.

The objectives of advance care planning are to learn about the types of decisions that may need to be made if individuals experience a serious illness, let others know about their preferences, and identify people who can speak to their wishes if needed.

Patient Priorities Care is appropriate through the life and health span. PPC is current care planning that provides patients, care partners, and clinicians the skills and knowledge to ensure care is integrated and focuses on each patient’s current health goals and preferences, not only when they develop a serious illness or cannot speak for themselves.

Patient-centered care is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient. It includes involving patients in their care.

Patient Priorities Care operationalizes this definition and provides the tools to systematically provide this type of care. This includes identifying what is meaningful and valuable to the patient and as importantly, the tools for clinicians to use to align their care with patients’ preferences, ensuring that patients’ values guide all decisions.

Palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for people living with serious illness. The goal is to improve quality of life for both the patient and the family.

Patient Priorities Care is an approach to decision-making for all patients with multiple chronic conditions, not only those with serious illness. Incorporating patient priorities identification and preparing all clinicians to translate those priorities into decision-making and care should improve the quality and effectiveness of palliative care and increase the number of persons offered palliative care.

Shared decision making (SDM) is a collaborative process that allows patients and their clinicians to make health care decisions together, considering the best scientific evidence available as well as the patient’s values and preferences. Shared decision making is usually applied to discrete treatment options for single diseases.

Patient Priorities Care provides a systematic and reliable means of ascertaining patients’ values, goals and preferences as recommended for SDM. Furthermore, Patient Priorities Care and SDM occur across conditions and are focused on attaining patients’ specific health goals, not only disease-specific outcomes. PPC is particularly useful with multiple conditions in which there are multiple decisions, making SDM unwieldy and potentially confusing if several separate decisions must be reconciled.

PPC is also helpful in the face of uncertainty, which is often the case for persons with multiple conditions who were excluded from many of the studies that inform SDM tools.

Evidence for Patient Priorities Care

Yes, there have been multiple studies showing the effectiveness and feasibility of the PPC approach and further studies are underway. Although challenging, implementing priorities aligned decision-making is feasible in a clinical setting with patients able to identify realistic goals that informed decision-making.

PPC has been associated with:

  • Reducing perceived treatment burden
  • Decreasing unwanted health care
  • Increasing wanted health care

Patients found the process valuable in identifying actionable health priorities and healthcare goals.

Patient Priorities Care does not ignore disease guidelines but rather acknowledges the uncertain applicability in older adults with multiple conditions who are often excluded from clinical trials. Older adults may accrue less benefit and more harm than suggested in disease guidelines because of competing coexisting conditions and treatments. Read more about care for older adults with multiple chronic conditions.

To guide decisions in the face of uncertainty for persons with multiple chronic conditions, clinicians should interpret disease guidelines through the lens of whether the recommendations are consistent with each patient’s health goals and health care preferences as well as their overall health trajectory and presence or competing conditions.

Identifying Health Priorities

Any member of the patient’s care team who is trained and has good interview skills can help patients identify their health priorities.

Patients can also identify their health priorities through a self-directed method at MyHealthPriorities.org or through a printable workbook.

Following our systematic set of steps with scripts and tips will result in specific, actionable, and realistic health outcome goals and care preferences that can inform decision making.

We have training and point-of-care materials available to prepare and support health care professionals in priorities identification. We also have patient and care partner materials. We have developed a case-based online curriculum with the American College of Physicians to prepare members of the healthcare team to become effective health priorities facilitators.

Putting Patient Priorities Care into practice

The first place you’ll start is our online curriculum, developed with the American College of Physicians. This training prepares members of the healthcare team to help patients identify their health goals and care preferences and to translate these goals and care preferences into decision-making.

Additionally, we have a toolkit to support those interested in implementing PPC. The best way to learn PPC is to do the training, then keep trying it with your patients. If you have any questions, don’t hesitate to contact us.

This will vary by site. Ideally, the patient’s health goals and health care preferences should be placed in the electronic health record in a place accessible by all health professionals to be used and updated as needed. We have created a simple, one-page summary to convey the key priorities-related information.

Each patient should also own a copy of their health priorities summary to take with them to every visit.

While most clinicians do consider patient preferences and goals, PPC can help them do this in a more systematic way—even providing guidance and troubleshooting for difficult cases. PPC ensures health goals and health care preferences are specific, realistic, and actionable enough to make the best decisions in the face of difficult tradeoffs.

Patients’ goals and preferences anchor conversations around the many tradeoffs involved in decision-making with patients with multiple conditions. Decision-making for clinicians shifts from, “You need (test or treatment) because of your (disease),” to “I’m recommending (starting, continuing, or stopping treatment) because it will help you achieve (patient’s health goal) and is consistent with (patient’s healthcare preference).”

Yes, Patient Priorities Care supports the clinical decision-making that is part of every clinical encounter and is billed like any other visit. Read more on billing guidance, including both inpatient and outpatient billing.

Patient Priorities Care definitions

Self-management tasks, medications, procedures, diagnostic tests, health care visits, etc.  patients are willing (or unwilling) and able (or unable) to do.

Specific, realistic, and actionable activities the patient wants to do that reflect their values and their health care can help them achieve. Unlike values, which are stable, Goals change what changes in life and health.

The health and life goals patients most desire within the context of their care preferences (i.e., what they are willing and able to do to achieve those health goals).

How a person’s health and functioning will likely change in the future.

Aligning health care decision-making and care with what matters most, patients’ own health priorities.

Any member of the patient’s care team who has good interview skills and is trained in health priorities identification who helps patients construct their health priorities and works with clinicians and patients to better align care with patients’ health priorities.

Health problem (i.e., burdensome symptom, health care task or medication) the patient finds most burdensome and most wants to address to help them achieve their health goal.

Occur when a patient needs to balance the benefits and burdens of alternatives, such as between conditions or between the effects of a condition and its treatment. Tradeoffs are also the difficult choices that patients must make about which treatments are worth the discomfort or burden because they help reach their goals.

The workload imposed by healthcare on patients and care partners and the effect this workload has on quality of life. Categories of workload include, among others: medications; self-management tasks; procedures; diagnostic and laboratory tests; and healthcare utilization, including clinician visits, hospitalization, and other interventions.

What matters most in a patient’s life and health—what gives life meaning, purpose, joy, or satisfaction. Values tend to remain stable, even with life and health changes.

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