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
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 comp...
Gespeichert in:
| Veröffentlicht in: | Journal of aging and health 2018-06, Vol.30 (5), p.778-799 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 799 |
|---|---|
| container_issue | 5 |
| container_start_page | 778 |
| container_title | Journal of aging and health |
| container_volume | 30 |
| creator | Ferris, Rosie Blaum, Caroline Kiwak, Eliza Austin, Janet Esterson, Jessica Harkless, Gene Oftedahl, Gary Parchman, Michael Van Ness, Peter H. Tinetti, Mary E. |
| description | 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. |
| doi_str_mv | 10.1177/0898264317691166 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1903438885</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0898264317691166</sage_id><sourcerecordid>2036662709</sourcerecordid><originalsourceid>FETCH-LOGICAL-c365t-a475edafa959655c9ab684c0b6a2010731a0ab308b8283933f90663975670f753</originalsourceid><addsrcrecordid>eNp1kV9rFDEUxYModq2--yQBX3xw9Gay-fdYBrWF1S2o-DhkZu50U2aSNckU-pX8lGbdVqHgUy7c3znnhkPISwbvGFPqPWija7nmTEnDmJSPyIoJUVdSa_WYrA7r6rA_Ic9SugaAmgF7Sk5qLQTXIFfk1yXGtMc-uxtMNIz00maHPqe3tJmcd72zvszWD_Qc7ZR39OttyjjTDdqhSGnwtNlZf1XUXxAHHGgO9GLex3CDNO_wXtbYiH9stkvuw3wM207Fg54Ny5QT_eEK9rmMbj9hMY2hxNMm-MFlF3x6Tp6Mdkr44u49Jd8_fvjWnFeb7aeL5mxT9VyKXNm1EjjY0RphpBC9sZ3U6x46aWtgoDizYDsOutO15obz0YCU3CghFYxK8FPy5uhb_vBzwZTb2aUep8l6DEtqmQG-5lrrA_r6AXodlujLdW0NXEpZKzCFgiPVx5BSxLHdRzfbeNsyaA89tg97LJJXd8ZLN-PwV3BfXAGqI5DsFf5L_a_hb9ZTpJw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2036662709</pqid></control><display><type>article</type><title>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</title><source>MEDLINE</source><source>SAGE Complete</source><creator>Ferris, Rosie ; Blaum, Caroline ; Kiwak, Eliza ; Austin, Janet ; Esterson, Jessica ; Harkless, Gene ; Oftedahl, Gary ; Parchman, Michael ; Van Ness, Peter H. ; Tinetti, Mary E.</creator><creatorcontrib>Ferris, Rosie ; Blaum, Caroline ; Kiwak, Eliza ; Austin, Janet ; Esterson, Jessica ; Harkless, Gene ; Oftedahl, Gary ; Parchman, Michael ; Van Ness, Peter H. ; Tinetti, Mary E.</creatorcontrib><description>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.</description><identifier>ISSN: 0898-2643</identifier><identifier>EISSN: 1552-6887</identifier><identifier>DOI: 10.1177/0898264317691166</identifier><identifier>PMID: 28553806</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Chronic illnesses ; Decision Making ; Female ; Health Services for the Aged - organization & administration ; Health Services for the Aged - standards ; Health Services Needs and Demand - organization & administration ; Health technology assessment ; Humans ; Male ; Multiple Chronic Conditions - epidemiology ; Multiple Chronic Conditions - therapy ; Objectives ; Older people ; Patient Participation ; Quality Improvement - organization & administration</subject><ispartof>Journal of aging and health, 2018-06, Vol.30 (5), p.778-799</ispartof><rights>The Author(s) 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-a475edafa959655c9ab684c0b6a2010731a0ab308b8283933f90663975670f753</citedby><cites>FETCH-LOGICAL-c365t-a475edafa959655c9ab684c0b6a2010731a0ab308b8283933f90663975670f753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0898264317691166$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0898264317691166$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28553806$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferris, Rosie</creatorcontrib><creatorcontrib>Blaum, Caroline</creatorcontrib><creatorcontrib>Kiwak, Eliza</creatorcontrib><creatorcontrib>Austin, Janet</creatorcontrib><creatorcontrib>Esterson, Jessica</creatorcontrib><creatorcontrib>Harkless, Gene</creatorcontrib><creatorcontrib>Oftedahl, Gary</creatorcontrib><creatorcontrib>Parchman, Michael</creatorcontrib><creatorcontrib>Van Ness, Peter H.</creatorcontrib><creatorcontrib>Tinetti, Mary E.</creatorcontrib><title>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</title><title>Journal of aging and health</title><addtitle>J Aging Health</addtitle><description>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.</description><subject>Aged</subject><subject>Chronic illnesses</subject><subject>Decision Making</subject><subject>Female</subject><subject>Health Services for the Aged - organization & administration</subject><subject>Health Services for the Aged - standards</subject><subject>Health Services Needs and Demand - organization & administration</subject><subject>Health technology assessment</subject><subject>Humans</subject><subject>Male</subject><subject>Multiple Chronic Conditions - epidemiology</subject><subject>Multiple Chronic Conditions - therapy</subject><subject>Objectives</subject><subject>Older people</subject><subject>Patient Participation</subject><subject>Quality Improvement - organization & administration</subject><issn>0898-2643</issn><issn>1552-6887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kV9rFDEUxYModq2--yQBX3xw9Gay-fdYBrWF1S2o-DhkZu50U2aSNckU-pX8lGbdVqHgUy7c3znnhkPISwbvGFPqPWija7nmTEnDmJSPyIoJUVdSa_WYrA7r6rA_Ic9SugaAmgF7Sk5qLQTXIFfk1yXGtMc-uxtMNIz00maHPqe3tJmcd72zvszWD_Qc7ZR39OttyjjTDdqhSGnwtNlZf1XUXxAHHGgO9GLex3CDNO_wXtbYiH9stkvuw3wM207Fg54Ny5QT_eEK9rmMbj9hMY2hxNMm-MFlF3x6Tp6Mdkr44u49Jd8_fvjWnFeb7aeL5mxT9VyKXNm1EjjY0RphpBC9sZ3U6x46aWtgoDizYDsOutO15obz0YCU3CghFYxK8FPy5uhb_vBzwZTb2aUep8l6DEtqmQG-5lrrA_r6AXodlujLdW0NXEpZKzCFgiPVx5BSxLHdRzfbeNsyaA89tg97LJJXd8ZLN-PwV3BfXAGqI5DsFf5L_a_hb9ZTpJw</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Ferris, Rosie</creator><creator>Blaum, Caroline</creator><creator>Kiwak, Eliza</creator><creator>Austin, Janet</creator><creator>Esterson, Jessica</creator><creator>Harkless, Gene</creator><creator>Oftedahl, Gary</creator><creator>Parchman, Michael</creator><creator>Van Ness, Peter H.</creator><creator>Tinetti, Mary E.</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201806</creationdate><title>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</title><author>Ferris, Rosie ; Blaum, Caroline ; Kiwak, Eliza ; Austin, Janet ; Esterson, Jessica ; Harkless, Gene ; Oftedahl, Gary ; Parchman, Michael ; Van Ness, Peter H. ; Tinetti, Mary E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-a475edafa959655c9ab684c0b6a2010731a0ab308b8283933f90663975670f753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Chronic illnesses</topic><topic>Decision Making</topic><topic>Female</topic><topic>Health Services for the Aged - organization & administration</topic><topic>Health Services for the Aged - standards</topic><topic>Health Services Needs and Demand - organization & administration</topic><topic>Health technology assessment</topic><topic>Humans</topic><topic>Male</topic><topic>Multiple Chronic Conditions - epidemiology</topic><topic>Multiple Chronic Conditions - therapy</topic><topic>Objectives</topic><topic>Older people</topic><topic>Patient Participation</topic><topic>Quality Improvement - organization & administration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferris, Rosie</creatorcontrib><creatorcontrib>Blaum, Caroline</creatorcontrib><creatorcontrib>Kiwak, Eliza</creatorcontrib><creatorcontrib>Austin, Janet</creatorcontrib><creatorcontrib>Esterson, Jessica</creatorcontrib><creatorcontrib>Harkless, Gene</creatorcontrib><creatorcontrib>Oftedahl, Gary</creatorcontrib><creatorcontrib>Parchman, Michael</creatorcontrib><creatorcontrib>Van Ness, Peter H.</creatorcontrib><creatorcontrib>Tinetti, Mary E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of aging and health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferris, Rosie</au><au>Blaum, Caroline</au><au>Kiwak, Eliza</au><au>Austin, Janet</au><au>Esterson, Jessica</au><au>Harkless, Gene</au><au>Oftedahl, Gary</au><au>Parchman, Michael</au><au>Van Ness, Peter H.</au><au>Tinetti, Mary E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Journal of aging and health</jtitle><addtitle>J Aging Health</addtitle><date>2018-06</date><risdate>2018</risdate><volume>30</volume><issue>5</issue><spage>778</spage><epage>799</epage><pages>778-799</pages><issn>0898-2643</issn><eissn>1552-6887</eissn><abstract>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.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>28553806</pmid><doi>10.1177/0898264317691166</doi><tpages>22</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0898-2643 |
| ispartof | Journal of aging and health, 2018-06, Vol.30 (5), p.778-799 |
| issn | 0898-2643 1552-6887 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1903438885 |
| source | MEDLINE; SAGE Complete |
| subjects | Aged Chronic illnesses Decision Making Female Health Services for the Aged - organization & administration Health Services for the Aged - standards Health Services Needs and Demand - organization & administration Health technology assessment Humans Male Multiple Chronic Conditions - epidemiology Multiple Chronic Conditions - therapy Objectives Older people Patient Participation Quality Improvement - organization & administration |
| title | 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 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T05%3A43%3A07IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Perspectives%20of%20Patients,%20Clinicians,%20and%20Health%20System%20Leaders%20on%20Changes%20Needed%20to%20Improve%20the%20Health%20Care%20and%20Outcomes%20of%20Older%20Adults%20With%20Multiple%20Chronic%20Conditions&rft.jtitle=Journal%20of%20aging%20and%20health&rft.au=Ferris,%20Rosie&rft.date=2018-06&rft.volume=30&rft.issue=5&rft.spage=778&rft.epage=799&rft.pages=778-799&rft.issn=0898-2643&rft.eissn=1552-6887&rft_id=info:doi/10.1177/0898264317691166&rft_dat=%3Cproquest_cross%3E2036662709%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2036662709&rft_id=info:pmid/28553806&rft_sage_id=10.1177_0898264317691166&rfr_iscdi=true |