Development of a clinically feasible process for identifying individual health priorities
- Autores: Aanand D. Naik, Lilian N. Dindo, Julia R. Van Liew, Natalie E. Hundt, Lauren Vo--, Kizzy Hernandez Bigos, Jessica Esterson, Mary Geda, Jonathan Rosen, Caroline S. Blaum, Mary E. Tinetti
- Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 10, 2018, págs. 1872-1879
- Idioma: inglés
- Enlaces
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Resumen
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.
