Think about the approach we take when buying a new car. We have a goal: purchase a safe, reliable car that is within budget. We have preferences: the car seats up to six, has automatic windows and door locks, and comes in the color black or silver. When purchasing a car, we consider our needs and our preferences and then make a final decision. This same process should be applied to our health care.
A new resource has been created to help clinicians and their patients tailor health care to what matters most to each person. Patient Priorities Care allows clinicians and patients to use materials found online to focus all decision making on the health priorities of the patient. Patient Priorities Care uses a specific process that first identifies a patient’s health priorities. Second, the clinician and patient jointly make decisions about the care provided – starting or stopping care based on the patient’s goals and preferences. The third step in the process is continuous assessment of patient priorities and ensuring alignment of care. The online tools available on the Patient Priorities Care website include resources to prepare the clinician and clinical practice to:
- elicit health priorities from patients, with accompanying materials for patients and caregivers so that they come ready for the conversations;
- address complexities in providing Patient Priorities Care, including implementing the American Geriatrics Society’s Multiple Chronic Conditions guiding principles;
- identify the business case and develop key partnerships to scale an effective approach to preparing patients, caregivers and clinicians to participate in Patient Priorities Care, and to ensuring that patient priorities become the standard of health care.
Available tools include conversation guides and templates for transmitting patients’ priorities through the electronic health record.
Health priorities refer to both an individual’s health outcome goals and care preferences – both are needed to drive decision making and care.
In the Patient Priorities Care context, health outcome goals are the personal health and life outcomes that patients hope to achieve through their health care (such as function, longevity, social activities, or symptom relief). SMART (specific, measurable, actionable, reliable and time bound) goals provide specificity so they can be used in making decisions. Care preferences refer to all aspects of health care (tests, health visits, procedures, medications) that individuals are able and willing to complete to achieve their health outcome goals.
Ensuring health care wishes are understood and followed
Patient Priorities Care is for anyone who wants their health priorities understood and honored by their loved ones and health care providers. It is particularly suited for older adults who are managing multiple conditions and navigating several clinicians. The foundation is working to improve care for people with multiple health conditions and who are limited in their ability to perform everyday tasks. Often called high-need patients, these individuals receive a lot of care and the care they get may not address what is most important to them. Patient Priorities Care recognizes that, when faced with trade-offs, older adults differ in their health outcome goals (what they want to achieve from their health care) and in their care preferences (what they are willing to do to achieve their goals).
As part of our work to improve the experience and outcomes of patient care, the foundation also supported development of an easy-to-use advanced directive for people to note their medical preferences without the aid of a clinician. An online tool, called PREPARE has been designed to take users through a brief five-step process resulting in a unique, printable document that can be shared with their family and clinicians. Other complementary efforts include programs that strengthen clinician communication skills so they can have more productive conversations with patients and their families around goals and preferences. These programs include VitalTalk, Ariadne Labs and Respecting Choices.
“Providing high-quality care to all patients requires clinicians, patients and family caregivers to work together to create a shared understanding of a patients’ goals, preferences and treatment options,” said Diane Schweitzer, acting chief program officer for the foundation’s Patient Care Program.
“Understanding patients’ values and wishes is especially important in our Patient Care Program’s work to improve the experience and outcomes of patient care.”
Other ongoing efforts in this area include support of the National Academy of Medicine to host a series of sessions on addressing the quality of care for people with serious illness. These sessions include clinicians, patients, caregivers and others who share in our goal of ensuring high-quality care for high-need patients.