Clinical trial NCT03600389: Patient Priorities Care (PPC)
Official title: Patient Priorities Care for Older Adults With Multiple Chronic Conditions Achieved Through Primary and Specialty Care Alignment: Patient Priorities Care (PPC)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Multiple Chronic Conditions
Keywords: Patient Health Priorities
Health Outcome Goals
Healthcare Preferences
Lead sponsor: Yale University
Sponsor class: OTHER
Collaborators: name: The John A. Hartford Foundation
name: Gordon and Betty Moore Foundation
name: Robert Wood Johnson Foundation
name: Patient-Centered Outcomes Research Institute
First posted: 2018-07-26
Enrollment: 414
Sex: ALL
Minimum age (years): 66
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Patient Priorities Care aligns healthcare decision-making and care by all clinicians with patients' own health priorities. Patient Priorities Care involves not only the health outcome goals that patients want to achieve, but also their preferences for healthcare. This approach is about aligning what outcomes patients want from their healthcare with what they are willing and able to do to achieve these outcomes. The approach begins with a member of the healthcare team helping patients identify their health outcome goals and their care preferences and preparing them to interact with their clinicians around these goals and preferences. The goals and preferences are transmitted to the patient's clinicians who use them in decision-making and communication with the patient and other clinicians.

Detailed description: Many older adults with Multiple Chronic Conditions receive conflicting recommendations and care that may be fragmented across clinicians. Older adults vary in what's most important when faced with tradeoffs and vary in the health-related activities they are willing and able to complete to achieve their desired outcomes. A potential solution to these problems is to move from decision-making predicated solely on disease-guidelines to decision-making based on achieving each patient's own specific health outcome goals (e.g., relief of symptoms sufficient to allow specific functional activity) within the context of what they are willing and able to do (i.e. care preferences) to achieve these outcomes.

The primary aims of the Patient Priorities Care (PPC) pilot is to assess the feasibility of aligning primary and specialty care to focus on the health priorities (i.e. specific and actionable outcome goals and care preferences) of older adults with multiple chronic conditions (MCC)

Eligibility criteria: Inclusion Criteria:

* Age \>65 years
* Member of Pro-Health Practice for \>=3 years
* Determined to be an appropriate candidate evidenced by ANY of the following:

  * Multiple Chronic Conditions (presence of \>3 active health problems)
  * \>10 medications
  * ≥ 1 hospitalization over the past year
  * ≥ 2 emergency department visits over the past year
  * Seen by \>2 specialists (excluding GYN and eye) over the past year

Exclusion Criteria:

* End stage renal disease
* Unable to consent (e.g. dementia)
* In hospice or meeting hospice criteria
* Nursing home resident
* Not English speaking

Primary outcomes:
measure: Treatment Burden Questionnaire (TBQ)
timeFrame: 6-12 Months
measure: Older Patient Assessment of Care for Chronic Conditions (O-PACIC)
timeFrame: 6-12 Months
measure: CollaboRATE
timeFrame: 6-12 Months
measure: Health Care Utilization
timeFrame: 6-12 months
Secondary outcomes:
measure: Older Patient Assessment of Care for Chronic Conditions (O-PACIC) subscales
timeFrame: 6-12 Months
measure: Combined items from the Treatment Burden Questionnaire (TBQ) that appear to measure similar constructs.
timeFrame: 6-12 Months
Other outcomes:
Locations:
Study officials:
References:
citation: Tinetti ME, Naik AD, Dindo L, Costello DM, Esterson J, Geda M, Rosen J, Hernandez-Bigos K, Smith CD, Ouellet GM, Kang G, Lee Y, Blaum C. Association of Patient Priorities-Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. JAMA Intern Med. 2019 Dec 1;179(12):1688-1697. doi: 10.1001/jamainternmed.2019.4235.