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Erschienen in: Journal of General Internal Medicine 12/2017

28.08.2017

Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives

verfasst von: Catherine Y. Lim, M.Des, Andrew B. L. Berry, MS, Tad Hirsch, PhD, Andrea L. Hartzler, PhD, Edward H. Wagner, MD, MPH, Evette J. Ludman, PhD, James D. Ralston, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 12/2017

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Abstract

Background

To improve care for individuals living with multiple chronic conditions, patients and providers must align care planning with what is most important to patients in their daily lives. We have a limited understanding of how to effectively encourage communication about patients’ personal values during clinical care.

Objective

To identify what patients with multiple chronic conditions describe as most important to their well-being and health.

Design

We interviewed individuals with multiple chronic conditions in their homes and analyzed results qualitatively, guided by grounded theory.

Participants

A total of 31 patients (mean age 68.7 years) participated in the study, 19 of which included the participation of family members. Participants were from Kaiser Permanente Washington, an integrated health care system in Washington state.

Approach

Qualitative analysis of home visits, which consisted of semi-structured interviews aided by photo elicitation.

Key Results

Analysis revealed six domains of what patients described as most important for their well-being and health: principles, relationships, emotions, activities, abilities, and possessions. Personal values were interrelated and rarely expressed as individual values in isolation.

Conclusions

The domains describe the range and types of personal values multimorbid older adults deem important to well-being and health. Understanding patients’ personal values across these domains may be useful for providers when developing, sharing, and following up on care plans.
Literatur
4.
Zurück zum Zitat Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of care for patients with multiple chronic conditions: the role of comorbidity interrelatedness. J Gen Intern Med. 2014;29(3):529-537. doi:10.1007/s11606-013-2616-9.CrossRefPubMed Zulman DM, Asch SM, Martins SB, Kerr EA, Hoffman BB, Goldstein MK. Quality of care for patients with multiple chronic conditions: the role of comorbidity interrelatedness. J Gen Intern Med. 2014;29(3):529-537. doi:10.​1007/​s11606-013-2616-9.CrossRefPubMed
6.
Zurück zum Zitat Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med. 2003;1(1):15-21.CrossRefPubMedPubMedCentral Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med. 2003;1(1):15-21.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Zulman DM, Kerr EA, Hofer TP, Heisler M, Zikmund-Fisher BJ. Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients. J Gen Intern Med. 2010;25(5):408-414.CrossRefPubMedPubMedCentral Zulman DM, Kerr EA, Hofer TP, Heisler M, Zikmund-Fisher BJ. Patient-provider concordance in the prioritization of health conditions among hypertensive diabetes patients. J Gen Intern Med. 2010;25(5):408-414.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Grant RW, Adams AS, Bayliss EA, Heisler M. Establishing visit priorities for complex patients: a summary of the literature and conceptual model to guide innovative interventions. Healthc Amst Neth. 2013;1(3–4):117-122. doi:10.1016/j.hjdsi.2013.07.008.CrossRef Grant RW, Adams AS, Bayliss EA, Heisler M. Establishing visit priorities for complex patients: a summary of the literature and conceptual model to guide innovative interventions. Healthc Amst Neth. 2013;1(3–4):117-122. doi:10.​1016/​j.​hjdsi.​2013.​07.​008.CrossRef
10.
Zurück zum Zitat National Quality Forum. Multiple Chronic Conditions Measurement Framework. Washington, D.C.: National Quality Forum; 2012. National Quality Forum. Multiple Chronic Conditions Measurement Framework. Washington, D.C.: National Quality Forum; 2012.
13.
Zurück zum Zitat Venkatesh A, Goodrich K, Conway PH. Opportunities for quality measurement to improve the value of care for patients with multiple chronic conditions. Ann Intern Med. 2014;161(10_Supplement):S76. doi:10.7326/M13-3014.CrossRefPubMed Venkatesh A, Goodrich K, Conway PH. Opportunities for quality measurement to improve the value of care for patients with multiple chronic conditions. Ann Intern Med. 2014;161(10_Supplement):S76. doi:10.​7326/​M13-3014.CrossRefPubMed
16.
Zurück zum Zitat Reuben DB, Tinetti ME. Goal-oriented patient care—an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777-779.CrossRefPubMed Reuben DB, Tinetti ME. Goal-oriented patient care—an alternative health outcomes paradigm. N Engl J Med. 2012;366(9):777-779.CrossRefPubMed
20.
Zurück zum Zitat Friedman B, Jr PHK, Borning A, Huldtgren A. Value sensitive design and information systems. In: Doorn N, Schuurbiers D, Poel I van de, Gorman ME, eds. Early Engagement and New Technologies: Opening up the Laboratory. Philosophy of Engineering and Technology. Netherlands: Springer; 2013:55-95. doi:10.1007/978-94-007-7844-3_4. Friedman B, Jr PHK, Borning A, Huldtgren A. Value sensitive design and information systems. In: Doorn N, Schuurbiers D, Poel I van de, Gorman ME, eds. Early Engagement and New Technologies: Opening up the Laboratory. Philosophy of Engineering and Technology. Netherlands: Springer; 2013:55-95. doi:10.​1007/​978-94-007-7844-3_​4.
22.
Zurück zum Zitat Lim C, Berry ABL, Hirsch T, et al. “It just seems outside my health”: how patients with chronic conditions perceive communication boundaries with providers. In: Proceedings of the 2016 ACM Conference on Designing Interactive Systems. DIS ‘16. Brisbane, Australia: ACM; 2016:1172–1184. doi:10.1145/2901790.2901866. Lim C, Berry ABL, Hirsch T, et al. “It just seems outside my health”: how patients with chronic conditions perceive communication boundaries with providers. In: Proceedings of the 2016 ACM Conference on Designing Interactive Systems. DIS ‘16. Brisbane, Australia: ACM; 2016:1172–1184. doi:10.​1145/​2901790.​2901866.
26.
Zurück zum Zitat Berry ABL, Lim C, Hartzler AL, et al. How values shape collaboration between patients with multiple chronic conditions and spousal caregivers. In: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems. CHI ‘17. Denver, CO: ACM; 2017. doi:10.1145/3025453.3025923. Berry ABL, Lim C, Hartzler AL, et al. How values shape collaboration between patients with multiple chronic conditions and spousal caregivers. In: Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems. CHI ‘17. Denver, CO: ACM; 2017. doi:10.​1145/​3025453.​3025923.
27.
Zurück zum Zitat Le Dantec CA, Edwards WK. Designs on dignity: perceptions of technology among the homeless. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI ‘08). 2008:627–636. doi:10.1145/1357054.1357155. Le Dantec CA, Edwards WK. Designs on dignity: perceptions of technology among the homeless. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI ‘08). 2008:627–636. doi:10.​1145/​1357054.​1357155.
28.
Zurück zum Zitat Charmaz K. Constructing grounded theory: a practical guide through qualitative research. Sage Publications Ltd Lond; 2006. Charmaz K. Constructing grounded theory: a practical guide through qualitative research. Sage Publications Ltd Lond; 2006.
33.
Zurück zum Zitat Witteman HO, Scherer LD, Gavaruzzi T, et al. Design features of explicit values clarification methods a systematic review. Med Decis Making. 2016:0272989X15626397. doi:10.1177/0272989X15626397. Witteman HO, Scherer LD, Gavaruzzi T, et al. Design features of explicit values clarification methods a systematic review. Med Decis Making. 2016:0272989X15626397. doi:10.​1177/​0272989X15626397​.
34.
Zurück zum Zitat Wieten S. “What the patient wants”: an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice. J Eval Clin Pract. 2015. doi:10.1111/jep.12471. Wieten S. “What the patient wants”: an investigation of the methods of ascertaining patient values in evidence-based medicine and values-based practice. J Eval Clin Pract. 2015. doi:10.​1111/​jep.​12471.
35.
Zurück zum Zitat Doukas DJ, McCullough LB. The values history: the evaluation of the patient’s values and advance directives. J Fam Pract. 1991;32:145-150.PubMed Doukas DJ, McCullough LB. The values history: the evaluation of the patient’s values and advance directives. J Fam Pract. 1991;32:145-150.PubMed
39.
Zurück zum Zitat Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12):1097-1102.CrossRef Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12):1097-1102.CrossRef
41.
Zurück zum Zitat Boyd CM, Reider L, Frey K, et al. The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial. J Gen Intern Med. 2010;25(3):235-242. doi:10.1007/s11606-009-1192-5.CrossRefPubMed Boyd CM, Reider L, Frey K, et al. The effects of guided care on the perceived quality of health care for multi-morbid older persons: 18-month outcomes from a cluster-randomized controlled trial. J Gen Intern Med. 2010;25(3):235-242. doi:10.​1007/​s11606-009-1192-5.CrossRefPubMed
42.
Zurück zum Zitat Wieland D, Boland R, Baskins J, Kinosian B. Five-year survival in a program of all-inclusive care for elderly compared with alternative institutional and home- and community-based care. J Gerontol A Biol Sci Med Sci. 2010;65A(7):721-726. doi:10.1093/gerona/glq040.CrossRef Wieland D, Boland R, Baskins J, Kinosian B. Five-year survival in a program of all-inclusive care for elderly compared with alternative institutional and home- and community-based care. J Gerontol A Biol Sci Med Sci. 2010;65A(7):721-726. doi:10.​1093/​gerona/​glq040.CrossRef
49.
51.
Zurück zum Zitat Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483.CrossRefPubMed Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483.CrossRefPubMed
54.
Zurück zum Zitat McDaid O, Hanly MJ, Richardson K, Kee F, Kenny RA, Savva GM. The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open. 2013;3(6):e002571. doi:10.1136/bmjopen-2013-002571.CrossRefPubMedPubMedCentral McDaid O, Hanly MJ, Richardson K, Kee F, Kenny RA, Savva GM. The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open. 2013;3(6):e002571. doi:10.​1136/​bmjopen-2013-002571.CrossRefPubMedPubMedCentral
55.
Zurück zum Zitat Berry ABL, Lim C, Hartzler AL, Hirsch T, Ludman EJ, Wagner EH. Eliciting values of patients with multiple chronic conditions: evaluation of a patient-centered framework. AMIA Annu Symp Proc. Forthcoming 2017. Berry ABL, Lim C, Hartzler AL, Hirsch T, Ludman EJ, Wagner EH. Eliciting values of patients with multiple chronic conditions: evaluation of a patient-centered framework. AMIA Annu Symp Proc. Forthcoming 2017.
Metadaten
Titel
Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients’ Perspectives
verfasst von
Catherine Y. Lim, M.Des
Andrew B. L. Berry, MS
Tad Hirsch, PhD
Andrea L. Hartzler, PhD
Edward H. Wagner, MD, MPH
Evette J. Ludman, PhD
James D. Ralston, MD, MPH
Publikationsdatum
28.08.2017
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 12/2017
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-017-4154-3

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