Patient Priorities-Aligned Care for Older Adults With Multiple Conditions: A Nonrandomized Controlled Trial.

Area of Science:

• Geriatric Medicine
• Health Services Research
• Patient-Centered Care

Background:

• Older adults with multiple chronic conditions often receive burdensome care lacking focus on patient priorities.
• Identifying and aligning care with patient health priorities can potentially improve health outcomes.

Purpose of the Study:

• To assess the association of patient priorities care (PPC) versus usual care (UC) with clinical outcomes in older adults with multiple chronic conditions.

Main Methods:

• A nonrandomized controlled trial with propensity adjustment enrolled 264 patients (≥65 years, ≥3 chronic conditions).
• The intervention involved guiding patients to identify values and priorities, with clinicians using these to guide care decisions (stop, start, continue).
• Outcomes included perceived treatment burden, PROMIS social roles, CollaboRATE scores, nonhealthy days, and shared prescribing decision quality, with 9-month and 365-day follow-ups.

Main Results:

• No statistically significant differences were found between PPC and UC for perceived treatment burden, CollaboRATE, or PROMIS social roles.
• PPC participants were nearly 2.5 times more likely to engage in shared prescribing decision-making (P=.07).
• Participants in the PPC group experienced a non-significant trend of 4.6 fewer nonhealthy days.

Conclusions:

• This priorities-aligned care trial did not demonstrate significant benefits for social roles or CollaboRATE.
• While not statistically significant, point estimates suggest PPC may hold promise for improving perceived treatment burden and shared prescribing decision-making.
• Larger randomized trials are necessary to definitively establish the effectiveness of priorities-aligned care.