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The increasing use of the question, "What matters most to you?" is a welcome development in the effort to provide patient‐centered care. However, it is difficult for clinicians to translate answers to this question into treatment plans for chronic conditions, including recognizing when to consider options other than clinical practice guideline (CPG)–directed therapy. Goal elicitation is most helpful when a patient has different treatment options with clearly identifiable trade‐offs. In the face of trade‐offs, goal elicitation helps patients to prioritize among potentially competing outcomes. While decision aids (DAs) focus on trade‐offs by delineating options and outcomes, the robust outcome data necessary to create DAs for older patients with multimorbidity are often lacking and even mild cognitive impairment makes the use of DAs difficult. The challenges for providing chronic disease care to older patients who are at risk for adverse events from CPG‐directed therapy because of multimorbidity and/or frailty are to organize the complexity of individual combinations of diseases, conditions, and syndromes into common sets of trade‐offs and to identify those goals or priorities that will directly inform a plan of care. J Am Geriatr Soc 68:474–477, 2020 [ABSTRACT FROM AUTHOR]

Objectives To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions ( MCCs) derived from an electronic health record ( EHR). Design Qualitative study using focus groups, interactive webinars, and a modified Delphi process. Setting Research department within an integrated delivery system. Participants The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions. Measurements Through webinars and the focus group, input was solicited on constructs representing high-quality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data. Results High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing. Conclusion High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to encourage holistic, person-centered care. [ABSTRACT FROM AUTHOR]

This is a response to the article by Paul Falzer. [ABSTRACT FROM AUTHOR]

See the Reply by Fried et al. [ABSTRACT FROM AUTHOR]