Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, USA.
Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
J Am Geriatr Soc. 2020 Sep;68(9):2112-2116. doi: 10.1111/jgs.16662. Epub 2020 Jul 20.
BACKGROUND/OBJECTIVES: Aligning healthcare decisions with patients' priorities may improve care for older adults with multiple chronic conditions (MCCs). We conducted a pilot study to assess the feasibility of identifying patient priorities in routine geriatrics care and to compare clinicians' recommendations for patients who did or did not have their priorities identified. DESIGN: Retrospective chart review. SETTING: Veterans Administration Medical Center Geriatrics Clinic. PARTICIPANTS: Older adults with MCCs receiving Patient Priorities Care (PPC; n = 35) were matched with patients receiving usual care (UC; n = 35). Both PPC and UC patients were cared for by three primary care providers (PCPs) in an ambulatory geriatric clinic. INTERVENTION: In the PPC group, a clinician facilitator met with each patient to identify their healthcare priorities and transmitted patients' priorities in the electronic health record (EHR). Trained PCPs then sought to align healthcare decisions with patients' priorities. In the UC group, patients received usual care from the same PCPs. MEASUREMENTS: We matched patients by clinician seen, patient's age, number of active conditions, medications, hospitalizations, functional status, and prior hospitalizations. EHRs were reviewed to identify care decisions including medications added or stopped, referrals and consults added or avoided, referrals to community services and supports, self-management activities added or avoided, and total number of changes to care. Mean differences in recommended care between PPC and UC patients from the same PCPs were examined. RESULTS: Clinician facilitators could identify patient priorities during routine clinic encounters. Compared with patients in the UC group, those in the PPC group had, on average, fewer medications added (P = .05), more referrals to community services and supports (P = .03), and more priorities-aligned self-management tasks added (P = .005). CONCLUSION: These findings support the feasibility of identifying and documenting patient priorities during routine encounters. Results also suggest that clinicians use patient priorities in recommending care.
背景/目的：使医疗决策与患者的优先事项保持一致，可能会改善患有多种慢性疾病（MCC）的老年患者的护理。我们进行了一项试点研究，以评估在常规老年病护理中确定患者优先事项的可行性，并比较对有或没有确定其优先事项的患者，临床医生的建议。
设计：回顾性图表审查。
地点：退伍军人事务部医疗中心老年病诊所。
参与者：接受患者优先护理（PPC；n=35）的患有 MCC 的老年人与接受常规护理（UC；n=35）的患者相匹配。PPC 和 UC 患者均由在门诊老年科的三名初级保健提供者（PCP）照顾。
干预措施：在 PPC 组中，临床医生协调员与每位患者会面，以确定他们的医疗保健优先事项，并在电子健康记录（EHR）中传输患者的优先事项。经过培训的 PCP 随后试图使医疗保健决策与患者的优先事项保持一致。在 UC 组中，患者从同一名 PCP 接受常规护理。
测量：我们通过就诊的临床医生、患者的年龄、活跃疾病的数量、药物、住院、功能状态和先前的住院情况对患者进行匹配。审查 EHR 以确定护理决策，包括添加或停止的药物、添加或避免的转诊和咨询、添加或避免的社区服务和支持转介、添加或避免的自我管理活动，以及护理变化的总数。检查了来自同一名 PCP 的 PPC 和 UC 患者之间推荐护理的平均差异。
结果：临床医生协调员可以在常规诊所就诊期间确定患者的优先事项。与 UC 组的患者相比，PPC 组的患者平均添加的药物更少（P=0.05），更多的转诊到社区服务和支持（P=0.03），更多的优先事项一致的自我管理任务添加（P=0.005）。
结论：这些发现支持在常规就诊期间确定和记录患者优先事项的可行性。结果还表明，临床医生在推荐护理时使用患者的优先事项。
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