For the one third of Americans who have multiple chronic conditions (MCC) ? defined as two or more long-term health problems ? care remains fragmented, with substantial care burdens, costs, functional limitations and premature mortality rates. Patients, their caregivers and their primary care providers (PCPs) are faced with a daunting list of care needs for those with MCC, often conflicting with the patient's life context. Effective interventions for patients with MCC are limited; there is a need for interventions that integrate patient contextual information into primary care encounters to improve patient-centered outcomes such as patient-perceived treatment burden. As noted in AHRQ's recent research priorities, including AHRQ Special Emphasis Notice NOT-HS-16-0137 to which we are applying, there is a need to develop and test interventions that integrate contextual information with clinical decision-making to optimize care processes and outcomes for persons with MCC. The objective of this proposal is to pilot test the integration of contextual information into pre-visit planning (PVP) as a method to help PCPs develop care plans that better fit the needs of patients with MCC, without significantly disrupting clinical workflows. In PVP, non-PCP health care team members call patients to gather key information prior to each office visit, resulting in enhanced patient experience, increased patient engagement and improved care efficiency including improved testing adherence in diabetes. To date, PVP has been focused on biomedical needs, without incorporating contextual information. PVP is an ideal method for gathering dynamic contextual information as it allows the PCP to quickly review summarized contextual information prior to each office visit with a patient with MCC, leaving the visit for counseling and decision-making with the patient. Our proposed intervention, context-informed PVP, is based on a conceptual model of care prioritization for MCC, constructed from our prior qualitative findings, the Chronic Care Model, the Cumulative Complexity Model, and other research. We propose to:
Aim 1 - refine a context-informed PVP intervention based on our preliminary data and the literature with stakeholders;
and Aim 2 - compare the context-informed PVP to standard PVP in a pilot randomized controlled trial (RCT) to determine intervention feasibility and acceptability, and estimate effect size on patient treatment burden to inform power calculations for a future, definitive RCT.
One third of Americans have multiple chronic conditions (MCC) ? defined as two or more long- term health problems ? with suboptimal health outcomes and high treatment burdens that often conflict with the patient's life context. Effective interventions are needed that integrate patient contextual information into primary care encounters to improve patient-centered outcomes. In the long-term, the proposed context-informed pre-visit planning intervention has the potential to decrease treatment burden and improve additional patient health outcomes.
