Aanand D Naik1,2, Lilian N Dindo1,2, Julia R Van Liew3, Natalie E Hundt1,2, Lauren Vo4, Kizzy Hernandez-Bigos4, Jessica Esterson5, Mary Geda5, Jonathan Rosen4, Caroline S Blaum6, Mary E Tinetti5,7. 1. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. 2. Houston Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston, Texas. 3. Veterans Affairs Central Iowa Health Care System, Des Moines, Iowa. 4. Connecticut Center for Primary Care, Farmington, Connecticut. 5. Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut. 6. School of Medicine, New York University, New York, New York. 7. Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut.
Abstract
OBJECTIVES: To develop a values-based, clinically feasible process to help older adults identify health priorities that can guide clinical decision-making. DESIGN: Prospective development and feasibility study. SETTING: Primary care practice in Connecticut. PARTICIPANTS: Older adults with 3 or more conditions or taking 10 or more medications (N=64). INTERVENTION: The development team of patients, caregivers, and clinicians used a user-centered design framework-ideate → prototype → test →redesign-to develop and refine the value-based patient priorities care process and medical record template with trained clinician facilitators. MEASUREMENTS: We used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions). RESULTS: We developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians. CONCLUSION: Trained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities.
OBJECTIVES: To develop a values-based, clinically feasible process to help older adults identify health priorities that can guide clinical decision-making. DESIGN: Prospective development and feasibility study. SETTING: Primary care practice in Connecticut. PARTICIPANTS: Older adults with 3 or more conditions or taking 10 or more medications (N=64). INTERVENTION: The development team of patients, caregivers, and clinicians used a user-centered design framework-ideate → prototype → test →redesign-to develop and refine the value-based patient priorities care process and medical record template with trained clinician facilitators. MEASUREMENTS: We used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions). RESULTS: We developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians. CONCLUSION: Trained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities.
Authors: Gregory M Ouellet; Eliza Kiwak; Darcé M Costello; Ariel R Green; Mary Geda; Aanand D Naik; Mary E Tinetti Journal: J Am Geriatr Soc Date: 2020-11-09 Impact factor: 5.562
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: 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: Jody L Lin; Catherine L Clark; Bonnie Halpern-Felsher; Paul N Bennett; Shiri Assis-Hassid; Ofra Amir; Yadira Castaneda Nunez; Nancy Miles Cleary; Sebastian Gehrmann; Barbara J Grosz; Lee M Sanders Journal: Acad Pediatr Date: 2020-06-12 Impact factor: 3.107