Patient Priority-Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions.
Older adults with multiple conditions receive care that is often fragmented, burdensome, and of unclear benefit. An advisory group of patients, caregivers, clinicians, health system engineers, health care system leaders, payers, and others identified three modifiable contributors to this fragmented, burdensome care: decision making and care focused on diseases, not patients; inadequate delineation of roles and responsibilities and accountability among clinicians; and lack of attention to what matters to patients and caregivers (ie, their health outcome goals and care preferences). The advisory group identified patient priority-directed care as a feasible, sustainable approach to addressing these modifiable factors.
Section of Geriatrics, Department of Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA; Yale School of Public Health, 60 College Street, New Haven, CT 06520, USA. Electronic address: mary.tinetti@yale.edu.
Mary E
ME
Tinetti
Section of Geriatrics, Department of Medicine, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA.
Jessica
J
Esterson
Division of Geriatric Medicine and Palliative Care, Department of Medicine, Langone Medical Center, New York University, 462 First Avenue, C&D Building, Room CD612-613, New York, NY 10016, USA; Department of Population Health, Langone Medical Center, New York University, 550 First Avenue, BCD612, New York, NY 10016, USA.
Rosie
R
Ferris
Oak Ridge Institute of Science Education, Oak Ridge Associated Universities, Oak Ridge, TN, USA; National MS Society, National Capitol Chapter.
Philip
P
Posner
Division of Geriatric Medicine and Palliative Care, Department of Medicine, Langone Medical Center, New York University, 462 First Avenue, C&D Building, Room CD612-613, New York, NY 10016, USA; Department of Population Health, Langone Medical Center, New York University, 550 First Avenue, BCD612, New York, NY 10016, USA.
Caroline S
CS
Blaum
D000368:Aged; D000066491:Clinical Decision-Making / Q000941:ethics / Q000379:methods; D003657:Decision Making / Q000941:ethics; D006801:Humans; D000071069:Multiple Chronic Conditions / Q000523:psychology / Q000628:therapy; D010347:Patient Care Planning; D000070659:Patient Comfort / Q000379:methods / Q000458:organization & administration; D057240:Patient Preference; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000523:psychology
Current care planning; Fragmented and burdensome care; Multiple chronic conditions; Patient priorities; Patient priority–directed care; Patient’s health outcome goals and care preferences