Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

Academic Article


  • OBJECTIVE: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. METHOD: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. RESULTS: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. DISCUSSION: Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.
  • Authors

  • Ferris, Rosie
  • Blaum, Caroline
  • Kiwak, Eliza
  • Austin, Janet
  • Esterson, Jessica
  • Harkless, Gene
  • Oftedahl, Gary
  • Parchman, Michael
  • Van Ness, Peter H
  • Tinetti, Mary E
  • Status

    Publication Date

  • June 2018
  • Published In


  • Aged
  • Decision Making
  • Female
  • Health Services Needs and Demand
  • Health Services for the Aged
  • Humans
  • Male
  • Multiple Chronic Conditions
  • Patient Participation
  • Quality Improvement
  • multiple chronic conditions
  • patient-centered metrics
  • patients’ health priorities
  • patient–clinician partnership
  • Digital Object Identifier (doi)

    Pubmed Id

  • 28553806
  • Start Page

  • 778
  • End Page

  • 799
  • Volume

  • 30
  • Issue

  • 5