Patient-Centered Prioritization of Health Care Processes for Multimorbidity

Primary care provides a broad service range, including preventive screenings and chronic disease care. Busy clinicians frequently select which health care processes to address per visit based on time or perceived disease impact, especially for patients with multimorbidity. Little evidence exists for how to prioritize processes by patient-centered health goals.

To identify criteria for prioritizing health care processes for patients with multimorbidity and using these criteria, develop recommended priority rankings of health care processes aligned with patient-centered health goals.

This consensus statement was developed using multicriteria decision analysis, a group consensus method. Using purposeful sampling, 21 national subject matter experts were recruited across 10 sites, with input from patient and health system partners. Experts completed 2 electronic survey rounds. The first round was conducted February 26 to April 2, 2024, with experts weighting 12 criteria for health care processes by importance (0-100 scale, with higher score indicating more importance) for addressing 3 common domains of patient-centered health goals (mortality, symptom relief, physical function) for hypothetical patients with multimorbidity. The second round was conducted June 3 to July 26, 2024, with experts scoring 53 health care processes by criteria (1-9 scale, with higher scores indicating greater priority). Experts received an evidence summary (publications through January 19, 2023) underlying health care processes. Weights and scores were combined as weighted sums, converted to process rankings per goal. Monte Carlo simulation (5000 randomizations) was used to evaluate confidence in findings (described as percentage of iterations at rank).

A total of 20 experts participated (95% response rate). Survey 1 determined attributes important for decision-making. Seven criteria were selected: actionability, safety impact, completion ease, impact on high-prevalence health issues, evidence quality, long-term health outcome impact, and validity. The second survey used these criteria to rank health care processes by patient goals. Tobacco use screening was the highest priority health care process for all goals (function: total score, 6.9 [49% of iterations ranked as No. 1]; mortality: total score, 7.4 [27% of iterations ranked as No. 1]; symptoms: total score, 7.1 [44% of participants ranked as No. 1]). Rankings for remaining health care processes varied by goal.

In this consensus statement, consideration of patient-centered health goals led to varied recommended decision-making criteria and prioritization of health care processes by subject matter experts. For patients with multimorbidity, these findings could inform systems evaluating health care process applications (eg, selection of screenings for patient-centered quality initiatives) or clinicians personalizing care delivery for patients (eg, catalyzing conversation about goals or efficiently addressing processes if goals are known).