A non-randomized control trial investigates whether older adults with multiple chronic conditions can benefit by receiving more specialized services.
It may come as no surprise that older adults who have multiple chronic conditions (MCC) are major users of healthcare, but perhaps what is more shocking is the fact that this said healthcare could have no specific benefit and could do more harm than good.
Using input provided by patients, care partners, clinicians, payers, and health system leaders, the authors of a study published in JAMA Network Open set out to investigate these issues by creating patient priorities care (PPC).1 This concept essentially focuses care on accomplishing patients’ health goals within the confines of their specific health conditions, along with the healthcare they are willing and able to receive.
Some could argue that disease-based decision-making in this area is siloed, the authors noted, so there is now an effort being made to change the mindset from “You need (intervention) to (prevent, treat, manage) (disease)” to “Knowing your health conditions, overall health, and what matters most to you, I suggest we (intervention) and see if it helps (patient goal).” In other words, this investigation set out to determine whether receiving health priorities–aligned primary care is in fact associated with patient-reported and healthcare utilization outcomes for older adults with MCC.
The study featured a nonrandomized controlled trial of 264 participants—a number sliced by nearly half, due to the protocol challenges caused by COVID-19—who were divided into two groups: those receiving PPC versus those who received usual care (UC); locations for these sites were Lakewood and Brunswick, Ohio respectively. Enrollment criteria included the need for patients to be cared for by participating primary care practitioners; being 65 years of age or older; three or more chronic conditions treated by any of 10 or more medications; two or more specialist visits; more than two emergency department visits or more than one hospitalization or 10 or more hospital days; having received care coordination services in the past year.
Enrollment took place between August 21, 2020, and May 14, 2021. Using a variety of patient-reported outcomes—such as the Treatment Burden Questionnaire, the achievement of desired activities that was measured by the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities Short Form 6a, CollaboRATE, and the Cleveland Clinic Accountable Care Organization—investigators were able to measure different treatment burden scores, odds of shared medication decision-making, and number of nonhealthy days.
By the conclusion of the trial, the authors determined that “although the findings of this nonrandomized controlled trial did not meet statistical significance, the group who received care aligned with patients’ health priorities did have better scores for treatment burden and shared prescribing decision-making. The former remained relatively stable in PPC participants while increasing among UC participants.”
As alluded to previously, there were various disruptions due to COVID, such as the reduced sample size; and despite there being criteria for selecting the sites, there was a disparity in the amount of representation of minoritized racial groups. Therefore, in conjunction with participant and/or site randomization, the investigators recommended that research be conducted in larger and more diverse settings.
1. Tinetti ME, Hashmi A, Ng H, et al. Patient Priorities–Aligned Care for Older Adults With Multiple Conditions: A Nonrandomized Controlled Trial. JAMA Netw Open. 2024;7(1):e2352666. doi:10.1001/jamanetworkopen.2023.52666