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8. Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions

Author

Ferris, Rosie, primary, Blaum, Caroline, additional, Kiwak, Eliza, additional, Austin, Janet, additional, Esterson, Jessica, additional, Harkless, Gene, additional, Oftedahl, Gary, additional, Parchman, Michael, additional, Van Ness, Peter H., additional, and Tinetti, Mary E., additional

Published
2017
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9. Clinician Perspectives on Incorporating Patients' Values‐Based Health Priorities in Decision‐Making.

Author

Ouellet, Gregory M., Kiwak, Eliza, Costello, Darcé M., Green, Ariel R., Geda, Mary, Naik, Aanand D., and Tinetti, Mary E.

Subjects
*MEDICAL communication, *COMORBIDITY, *CHRONIC diseases, *MEDICAL care for older people, *PATIENT-centered care, *DECISION making in clinical medicine, *PATIENTS' attitudes, *PHYSICIANS' attitudes
Abstract

The authors report on the use of a Patient Priorities Care (PPC) approach to medical care for older patients with multiple chronic conditions. They discuss the use of PPC in clinical care, the perceived benefits and difficulties of discussing priorities with the patient, and how the clinicians felt about the process.

Published
2021
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10. Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

Author

Ferris, Rosie, Blaum, Caroline, Kiwak, Eliza, Austin, Janet, Esterson, Jessica, Harkless, Gene, Oftedahl, Gary, Parchman, Michael, Van Ness, Peter H., and Tinetti, Mary E.

Subjects
ATTITUDE (Psychology), CHANGE, CHRONIC diseases, COMMUNICATION, HEALTH services accessibility, MEDICAL care, EVALUATION of medical care, MEDICAL quality control, MEDICAL personnel, MEDICAL protocols, PATIENTS, PHYSICIAN-patient relations, QUALITY assurance, DECISION making in clinical medicine, DATA analysis, PATIENTS' attitudes
Abstract

Objective: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Method: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Results: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Discussion: Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians. [ABSTRACT FROM AUTHOR]

Published
2018
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