420 Participants Needed

Patient Priorities Care for Multiple Chronic Conditions

(PPC Trial)

Recruiting at 1 trial location
AD
LN
Overseen ByLilian N Dindo, PhD
Age: 65+
Sex: Any
Trial Phase: Academic
Sponsor: VA Office of Research and Development
Approved in 1 JurisdictionThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

The investigators will conduct a randomized control trial enrolling 366 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.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, since the trial involves patients with multiple chronic conditions who are prescribed 10 medications, it seems likely that you can continue your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems likely that you can continue your current medications, as the trial focuses on aligning care with patient priorities.

What data supports the idea that Patient Priorities Care for Multiple Chronic Conditions is an effective treatment?

The available research shows that Patient Priorities Care (PPC) is effective for older adults with multiple chronic conditions. In a study involving 119 older adults, 77% returned to their primary care provider after having their priorities identified, and in 46% of these visits, clinicians documented discussions about patient priorities. This suggests that PPC helps align healthcare with what matters most to patients, making it a feasible and beneficial approach compared to usual care, which often doesn't focus on patient priorities.12345

What data supports the effectiveness of the treatment Patient Priorities Care for Multiple Chronic Conditions?

Patient Priorities Care (PPC) helps align healthcare with what matters most to older adults with multiple chronic conditions, making care less burdensome and more focused on their personal goals. Studies show that PPC is feasible to implement and can improve care by ensuring that healthcare decisions reflect patients' priorities.12345

What safety data exists for Patient Priorities Care for multiple chronic conditions?

The provided research does not directly address safety data specific to Patient Priorities Care (PPC) for multiple chronic conditions. The studies focus on the feasibility and implementation of aligning care with patient priorities and the general importance of patient safety in healthcare. However, they do not provide specific safety outcomes or data related to PPC.12678

Is Patient Priorities Care safe for people with multiple chronic conditions?

The available research does not provide specific safety data for Patient Priorities Care, but it emphasizes the importance of aligning care with patient priorities to potentially improve care quality for older adults with multiple chronic conditions.12678

Is Patient Priorities Care a promising treatment for people with multiple chronic conditions?

Yes, Patient Priorities Care is promising because it focuses on what matters most to patients, helping doctors make better decisions for older adults with multiple health issues.124910

How is the Patient Priorities Care treatment different from other treatments for multiple chronic conditions?

Patient Priorities Care (PPC) is unique because it focuses on aligning healthcare decisions with what matters most to the patient, especially older adults with multiple chronic conditions. This approach involves identifying and documenting patient priorities in their electronic health records, ensuring that care is tailored to their individual goals and preferences.124910

Research Team

LN

Lilian N. Dindo, PhD

Principal Investigator

Michael E. DeBakey VA Medical Center, Houston, TX

Eligibility Criteria

This trial is for older veterans with multiple chronic conditions who have had at least two medical appointments in the past 18 months, are on ten or more medications, and have three active health issues. They must be able to give informed consent and not be expected to pass away within a year. Those with severe mental illness, dementia, substance abuse, complete hearing loss, frequent no-shows for appointments, nursing home residents or those needing a translator are excluded.

Inclusion Criteria

2 encounters in prior 18 months
I have 3 active health issues or am taking 10 medications.

Exclusion Criteria

Dementia
I need a translator to communicate in English.
I am on dialysis for end-stage kidney disease.
See 7 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-3 weeks
1 visit (in-person)

Patient Priorities Care Facilitation

A facilitator conducts a structured assessment to establish patient priorities and goals before the PCP visit.

2-3 weeks
1 visit (in-person)

Treatment

PCPs align care with patients' priorities using established decisional strategies.

4 months
Regular visits as per usual care schedule

Follow-up

Participants are monitored for treatment burden, home and community services use, shared decision making, and goal setting.

4 months

Treatment Details

Interventions

  • Patient Priorities Care
  • Usual Care
Trial OverviewThe study compares Patient Priorities Care—a method focusing on patients' personal health priorities and reducing treatment burden—with usual care among veterans. Participants will be randomly assigned to either approach to see if it better aligns treatments with their life goals and reduces healthcare strain.
Participant Groups
2Treatment groups
Experimental Treatment
Placebo Group
Group I: Patient Priorities CareExperimental Treatment1 Intervention
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.
Group II: Usual CarePlacebo Group1 Intervention
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

Patient Priorities Care is already approved in United States for the following indications:

🇺🇸
Approved in United States as Patient Priorities Care for:
  • Multiple Chronic Conditions
  • Geriatric Care

Find a Clinic Near You

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials
1,691
Recruited
3,759,000+

Findings from Research

The study developed a natural language processing (NLP) model that accurately identifies when clinicians document patient priorities in electronic health records, achieving a high accuracy of 0.92 during validation.
Out of 778 patient notes analyzed, 75.7% contained patient priorities language, demonstrating the model's effectiveness in measuring the adoption of the Patient Priorities Care (PPC) model in clinical settings.
Measuring Adoption of Patient Priorities-Aligned Care Using Natural Language Processing of Electronic Health Records: Development and Validation of the Model.Razjouyan, J., Freytag, J., Dindo, L., et al.[2021]
In a pilot study involving 70 older adults with multiple chronic conditions, identifying patient healthcare priorities during routine visits led to fewer medications being added for those in the Patient Priorities Care (PPC) group compared to usual care (UC) patients.
Patients in the PPC group received more referrals to community services and aligned self-management tasks, indicating that incorporating patient priorities can enhance care decisions and better meet individual needs.
Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care.Freytag, J., Dindo, L., Catic, A., et al.[2021]
A systematic review of 24 studies revealed a low level of agreement between the health priorities of patients with multimorbidity and those of clinicians, indicating a potential gap in understanding patient needs.
Patients prioritized preserving their functional ability based on their personal illness experiences, while clinicians tended to focus on long-term health risks, highlighting the importance of aligning treatment goals for better patient-centered care.
Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review.Sathanapally, H., Sidhu, M., Fahami, R., et al.[2021]

References

Measuring Adoption of Patient Priorities-Aligned Care Using Natural Language Processing of Electronic Health Records: Development and Validation of the Model. [2021]
Feasibility of Clinicians Aligning Health Care with Patient Priorities in Geriatrics Ambulatory Care. [2021]
Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review. [2021]
Guiding Post-Hospital Recovery by 'What Matters:' Implementation of Patient Priorities Identification in a VA Community Living Center. [2023]
Feasibility of Implementing Patient Priorities Care for Older Adults with Multiple Chronic Conditions. [2020]
Patient safety. Remember who it's really for. [2004]
Patient Safety in Primary Care: Conceptual Meanings to the Health Care Team and Patients. [2021]
Harm caused by adverse events in primary care: a clinical observational study. [2009]
Challenges and strategies in patients' health priorities-aligned decision-making for older adults with multiple chronic conditions. [2023]
Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study. [2022]