Patient Priorities Care grew from the observations of health professionals who saw that traditional, disease-based health care wasn’t giving older adults with multiple chronic conditions the outcomes they truly wanted. Dr. Mary Tinetti, a geriatrician and researcher with decades of experience, was one of those health professionals.
In the early 2000s, Amy Berman of The John A. Hartford Foundation noticed a similar disconnect in health care, particularly in the interactions between primary clinicians and specialists. She approached Tinetti to lead an initiative to improve older adults’ primary and specialty care, sparking the concept of what became Patient Priorities Care.
Health care is focused on managing isolated diseases. Disease-guidelines are based on studies that, for the most part, excluded older adults, especially those with multiple chronic conditions. The result for patients was too many health care appointments and too many medications, tests, and procedures, some of which caused problems without offering much benefit.
All this health care didn’t necessarily help older adults do what made life fulfilling—what mattered most to them. The siloed, disease-guideline approach wasn’t serving many older patients.
“It became clear that the way we make decisions about each condition in isolation and focus on them independently didn’t make a lot of sense,” says Tinetti. “It worsens the complexity and/or burden for patients and health professionals rather than simplifying. It seemed like there was a better way.”
A Better Way
At that time, and even now, most research focused on single diseases. Emergent work from researchers like Dr. Terri Fried found that older adults with severe and advanced conditions varied in what they wanted from their health care, especially when faced with important tradeoffs. There wasn’t one solution that worked for everyone.
Tinetti and Patient Priorities Care co-founder Dr. Caroline Blaum posed a crucial question: If we are unsure about a single right answer, if disease-centric care doesn’t always work well and gets in the way of what matters most to people and people vary in what matters to them, then what is the logical solution?
“Ask people what matters to them about their health and make your decisions based on it,” they answered.
Assembling a Team
A national team of clinicians, patients, caregivers, health system leaders, payers, and funders came together in 2014 to identify the key problems facing older adults with multiple chronic conditions. Leading the charge alongside Tinetti were Blaum and Dr. Aanand Naik. Collectively, they developed the core elements for patient priorities-directed care.
This effort was supported jointly by The John A. Hartford Foundation and Patient-Centered Outcomes Research Institute.
Launching the Pilot
In 2015, Patient Priorities Care launched its pilot phase.
The pilot tested effective and feasible ways to identify and communicate 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.
It compared the outcomes of patients who did and did not receive their primary care from clinicians trained in patient priorities-aligned care to understand its impact on patient- and clinician-reported outcomes, healthcare burden, and healthcare utilization in a real-world healthcare environment.
Participants receiving patient priorities-aligned care vs. usual care reported a greater reduction in treatment burden, and their health records reflected more unwanted medications stopped and fewer unwanted self-management tasks and diagnostic tests.
This phase of the project was funded by The John A. Hartford Foundation, the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation.
Reaching Patients Across the Country
Our aim for Patient Priorities Care is to improve health outcomes for patients everywhere—based on what that means to each individual—and providing health professionals with the tools to make that happen.