Patient-Centered Prioritization of Health Care Processes for Multimorbidity.

Area of Science:

• Health Services Research
• Clinical Decision Making
• Patient-Centered Care

Background:

• Primary care encompasses diverse services, including preventive screenings and chronic disease management.
• Clinicians often prioritize healthcare processes based on time constraints or perceived disease impact, particularly for patients with multimorbidity.
• Limited evidence exists on prioritizing healthcare processes according to patient-centered health goals.

Purpose of the Study:

• To identify criteria for prioritizing healthcare processes in multimorbidity care.
• To develop recommended priority rankings for healthcare processes aligned with patient-centered health goals.

Main Methods:

• A consensus statement was developed using multicriteria decision analysis with 21 national experts.
• Two electronic survey rounds were conducted to weight criteria and score 53 healthcare processes against patient goals (mortality, symptom relief, physical function).
• Monte Carlo simulation was used to assess confidence in the derived rankings.

Main Results:

• Seven criteria were selected: actionability, safety impact, completion ease, impact on high-prevalence issues, evidence quality, long-term outcome impact, and validity.
• Tobacco use screening was ranked as the highest priority healthcare process for all patient goals.
• Rankings for other healthcare processes varied depending on the specific patient goal.

Conclusions:

• Prioritizing healthcare processes based on patient-centered goals yields varied criteria and rankings.
• Findings can inform health systems in selecting quality initiatives and aid clinicians in personalizing care for patients with multimorbidity.
• This approach facilitates goal-oriented conversations and efficient process management in clinical practice.