Patient Priorities Care Shows Potential for Improving Outcomes for Older Adults with Multiple Chronic Conditions < Yale School of Medicine

In a new JAMA Network Open study, researchers explored the impact of Patient Priorities Care (PPC) on older adults with multiple chronic conditions. PPC is an approach to care that addresses the what Matters Most “M” of the Age-Friendly Healthcare Systems 4Ms framework by identifying patients’ health priorities and aligning care and decision-making around those priorities.

The nonrandomized clinical trial conducted at a Cleveland Clinic primary care multisite practice, co-led by Mary E. Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Ardeshir Hashmi, MD, endowed chair of Geriatric Innovation and section chief of Cleveland Clinic’s Center for Geriatric Medicine, showed trends toward greater likelihood of shared decision-making, decreased treatment burden, and decreased number of nonhealthy days – the number of days in the hospital, emergency department, skilled nursing facility, or ambulatory facility for a prolonged procedure.

Results reached marginal statistical significance, largely attributed to smaller than planned enrollment and protocol changes required by the COVID-19 pandemic that coincided with the planned initiation of the study in 2020.

“Given all the challenges and modifications we had to make because of COVID — including cutting our sample size in half — we were pleasantly surprised we were able to find trends toward the benefits of patient priorities-aligned care,” says Tinetti.

Almost 2.5 times as many patients participating in Patient Priorities Care as opposed to usual care felt clinicians involved them in decision making around their prescription medications. For Cleveland Clinic’s Accountable Care Organization (ACO), shared decision making is a quality metric.

“I didn’t realize Patient Priorities Care would be the one thing that would really move the needle on this,” says Hashmi. “It’s encouraging, and it gives us the impetus to scale this across our health system.”

A 2019 clinical study led by Tinetti also found decreased treatment burden using Patient Priorities Care.

“For people with multiple chronic conditions who often spend so much time and effort on their health care, this is a major outcome,” says Tinetti. “The fact that we found similar effects in both studies is important.”

Although the trend toward fewer nonhealthy days was modest, Tinetti says this evidence implies that patient outcomes can be improved with less health care utilization.

While some of the primary care physicians first responded to PPC with skepticism, viewing the approach as “just one more thing” according to Hashmi, none of the physicians wanted to stop the project even at the height of the pandemic.

Henry Ng, MD, director of Transgender Surgery & Medicine Program and director for the Center for LGBTQ+ Care at Cleveland Clinic, was a physician who participated in the study.

“Participating in Patient Priorities Care changed how I relate to my patients at a fundamental level,” says Ng. “Identifying, discussing, and aligning care plan recommendations has become a central part of my communication to patients and families of all ages. I have found that using PPC tools has helped me discover and support my patients’ health needs and overall life goals. Patients have responded telling me they feel seen and heard.”

Further research, especially in larger and more diverse settings, is needed to substantiate these trends.

“Patient Priorities Care as a paradigm was durable enough to survive through the height of the pandemic and still show trends,” says Hashmi. “We’re just seeing the tip of the iceberg.”

In addition to Tinetti, Hashmi, and Ng, other authors on the study include Margaret Doyle, MPH; Toyomi Goto, MA; Jessica Esterson, MPH; Aanand Naik, MD; Lilian Dindo, PhD; and Fan Li, PhD.

Read “Patient Priorities-Aligned Care for Older Adults with Multiple Chronic Conditions: A Nonrandomized Controlled Trial” in JAMA Network Open.

Patient Priorities Care (PPC) offers evidence-based tools and resources to help patients, care partners, and clinicians focus decision-making and healthcare on what Matters Most: patients’ own health priorities. Patient Priorities Care is suitable for any patient, but especially older adults managing multiple chronic conditions. PPC is a Yale research project from the Department of Internal Medicine’s Section of Geriatrics, led by co-creator Mary Tinetti, MD, who is the principal investigator on the grant. PPC is now focusing efforts on spreading awareness and training clinicians and older adults and their care partners across the U.S.

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