Patient Priorities Care for Older Adults With Multiple Chronic Conditions Achieved Through Primary and Specialty Care Alignment: Patient Priorities Care (PPC)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 414
- 主要终点
- CollaboRATE
研究概览
简要总结
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.
详细描述
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)
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Interviewer and chart abstractor is blinded to the nature of the intervention and to the group assignment.
入排标准
- 年龄范围
- 66 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •End stage renal disease
- •Unable to consent (e.g. dementia)
- •In hospice or meeting hospice criteria
- •Nursing home resident
- •Not English speaking
研究组 & 干预措施
Intervention Arm (Implementing Patient Priorities Care)
Aligning healthcare recommendations to achieve patients' specific health outcome goals within the context of what patients are willing and able to do.
干预措施: Patient Priorities Care (Behavioral)
Control Arm (Not Implementing Patient Priorities Care)
Routine Care
结局指标
主要结局
CollaboRATE
时间窗: 6-12 Months
Measure of shared decision making in clinical encounters. Summary score is 0-100 with higher score indicated greater shared decision making. This is an exploratory study and the investigator will compare the intervention to control group to determine if the intervention group scores higher on CollaboRATE (i.e. greater shared decision-making).
Older Patient Assessment of Care for Chronic Conditions (O-PACIC)
时间窗: 6-12 Months
Measure to assess chronically-ill patients' perceptions of the degree to which health care delivery is integrated and coordinated. Summary score is 1-5 with higher score indicated greater integration. This is an exploratory study and the investigators will compare the intervention to control group to determine if the intervention group scores higher on O-PACIC (i.e. greater integration).
Treatment Burden Questionnaire (TBQ)
时间窗: 6-12 Months
Measure to assess treatment burden among patients with one or more chronic conditions. Summary score is 0-150 with lower numbers indicating less burden. This is an exploratory study and the investigators will compare the intervention to control group to determine if the intervention group scores are lower on the TBQ (i.e. less burden).
Health Care Utilization
时间窗: 6-12 months
Measures of changes in health care utilization drawn from review of patient medical records
次要结局
- Older Patient Assessment of Care for Chronic Conditions (O-PACIC) subscales(6-12 Months)
- Combined items from the Treatment Burden Questionnaire (TBQ) that appear to measure similar constructs.(6-12 Months)