OBJECTIVE: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. METHOD: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. RESULTS: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. DISCUSSION: Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.
OBJECTIVE: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. METHOD: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. RESULTS: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. DISCUSSION: Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.
Authors: Shelli L Feder; Eliza Kiwak; Darcé Costello; Lilian Dindo; Kizzy Hernandez-Bigos; Lauren Vo; Mary Geda; Caroline Blaum; Mary E Tinetti; Aanand D Naik Journal: J Am Geriatr Soc Date: 2019-03-07 Impact factor: 5.562
Authors: Thomas A Arcury; Joanne C Sandberg; Kathryn P Melius; Sara A Quandt; Xiaoyan Leng; Celine Latulipe; David P Miller; D Alden Smith; Alain G Bertoni Journal: J Appl Gerontol Date: 2018-10-24
Authors: Mary F Wyman; Daniel Liebzeit; Corrine I Voils; Barbara J Bowers; Elizabeth N Chapman; Andrea Gilmore-Bykovskyi; Korey A Kennelty; Amy J H Kind; Julia Loosen; Nicole Rogus-Pulia; Melissa Dattalo Journal: Patient Educ Couns Date: 2020-02-15
Authors: Caroline S Blaum; Jonathan Rosen; Aanand D Naik; Cynthia D Smith; Lilian Dindo; Lauren Vo; Kizzy Hernandez-Bigos; Jessica Esterson; Mary Geda; Rosie Ferris; Darce Costello; Denise Acampora; Thomas Meehan; Mary E Tinetti Journal: J Am Geriatr Soc Date: 2018-10-03 Impact factor: 5.562
Authors: Neeltje P Vermunt; Mirjam Harmsen; Glyn Elwyn; Gert P Westert; Jako S Burgers; Marcel G Olde Rikkert; Marjan J Faber Journal: Health Expect Date: 2017-11-28 Impact factor: 3.377