Effect of Patient Priorities Care Implementation in Older Veterans With Multiple Chronic Conditions (PPC)

VA Office of Research and Development

Status: Completed

Conditions: Multiple Chronic Conditions; Decision Making, Shared

Treatments: Behavioral: Patient Priorities Care; Other: Usual Care

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT04922320

CIN 13-413 (Other Grant/Funding Number)

IIR 20-079

1 I01 HX003211-01A1 (Other Grant/Funding Number)

Details and patient eligibility

About

The investigators will conduct a randomized control trial enrolling 420 older Veterans with multiple chronic conditions receiving primary care at the Michael E. DeBakey VA Medical Center and VA Connecticut Medical Center to determine if Patient Priorities Care reduces treatment burden, increases priorities-aligned home and community services, and sets shared health outcome goals compared with usual care. The investigators will randomize at the patient level rather than clinic or clinician level to evaluate the effect of identifying patient priorities on clinician decision making and alignment of care with identified priorities.

Enrollment: 420 patients

Sex: All

Ages: 65+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 2 encounters in prior 18 months
• 3 active health problems on active problem list or prescribed 10 medications

Exclusion criteria

• nursing home resident

• end stage renal disease on dialysis

• active serious mental illness (psychosis, schizophrenia, etc)

• active substance use disorder

• complete hearing loss

• dementia

• Non-English speaker (translator required)

• 4 or more no-show appointments in the last 6 months

• the investigators will present a list of eligible patients to PCPs prior to chart review to identify patients who the PCP:

  • a) believes cannot participate independently or provide informed consent due to cognitive impairment
  • b) "would not be surprised if the patient passed away within the next 12 months?"

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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420 participants in 2 patient groups, including a placebo group

Patient Priorities Care

Experimental group

Description:

A facilitator will schedule a PPC facilitation encounter 2-3 weeks before an upcoming PCP visit. The facilitator conducts a structured assessment using a written conversation guide that begins with general questions establishing what is most important to Veterans about their health and moves toward establishing specific goals (actionable outcomes), and what patients are willing/not willing to do to achieve these goals (care preferences). The result is a structured patient priorities report delivered to PCPs designed to facilitate changes in the patient's care plan to align it with his/her priorities. In the subsequent visit, the PCP will use one or more of the established PPC decisional strategies to align care with patients' priorities. Education for PCPs about the facilitation process, the patient priorities report, and the decisional strategies occurs prior to the PCP seeing any intervention patients. The PCP will document changes in care made to achieve the identified priorities.

Treatment:

Behavioral: Patient Priorities Care

Usual Care

Placebo Comparator group

Description:

PCPs will not be alerted when an encounter involves a UC group participant. UC participant visits will appear the same as all other unenrolled patient encounters. UC participants will not receive any additional preparation

Treatment:

Other: Usual Care