Study Demonstrates Feasibility of Patient Priorities Care in a Community Living Center
By Crystal Gwizdala
Managing daily health care tasks can become burdensome, especially if you’re an older adult with three or more chronic disorders. To further complicate things, treatment recommendations for conditions may conflict. Age-friendly care has emerged to redesign health care delivery in a way that aligns with what matters most to the individual. Implementing this approach to care, however, demands a cultural shift in many health systems, including community living centers.
A new Geriatrics study has shown that a patient-centered approach, Patient Priorities Care (PPC), is a feasible way to ask what matters in a Veterans Affairs Community Living Center (CLC) or skilled nursing facility.
Rather than focusing on treating diseases in isolation, the approach supports patients in achieving goals aligned with their values. PPC is an age-friendly approach to care that helps patients, care partners, and clinicians focus decision-making and health care on patients’ health priorities.
The study was performed in a CLC based in Puget Sound over an eight-month period. Frontline staff were trained on the PPC approach to facilitate the health priorities identification (HPI) process. These facilitators represented a variety of health professions such as a registered nurse, physician, occupational therapist, psychologist, and chaplain. Throughout the study, trained facilitators completed HPI discussions with all new admissions into the CLC that included all core HPI steps. These conversations influenced documentation of the interdisciplinary team meetings in 78% of encounters.
A Focus on What Matters Most to Patients
CLC staff felt PPC was appropriate for community living centers, benefitted patient care, and required intentional leadership and interdisciplinary collaboration to build a more person-centered culture.
“Learning what matters most helps build connection between veteran and provider, and learning those important things about veterans helps build rapport,” said a facilitator during a qualitative interview. “The veteran is more likely to remember who she [facilitator] is; it definitely helps with veteran engagement in their rehab.”
Barriers identified to implementing this approach were staffing vacancies, patient-related cognitive impairment (e.g., dementia, severe psychological distress), resistance to culture change, and confidence to probe if the HPI conversation stalls.
While it took time to acclimate to the approach, the creation of a template in the electronic health record strengthened facilitator skills in defining health care goals, resulting in clearer communication amongst members of the interdisciplinary team. Because of the initial time investment, researchers stated that leadership support is instrumental for program integration.
Learn more about the research in “Guiding Post-Hospital Recovery by ‘What Matters:’ Implementation of Patient Priorities Identification in a VA Community Living Center.”