Enhanced Care Planning Study: Patient Needs, Care Plan Topics, and Health-Related Quality of Life

Context: Patients with multiple chronic conditions (MCC) have unmet social needs, mental health challenges, and unhealthy behaviors. Both chronic disease and health- related needs influence a patient's quality of life (QOL). One approach to addressing patient needs and QOL is through care planning. However, little is understood about the relations between patient QOL, health-related needs, and care planning preferences. Objective: To describe how patients' health-related quality of life relates to their unmet needs and the care plans they choose to create. Study Design and Analysis: In a cross-sectional study design, we compared the association between health-related quality of life with the following domains: unmet social needs, mental health needs, lifestyle behavior needs, and the care plan topics they chose to address. Dataset: Data from a randomized control trial investigating enhanced care planning. Population Studied: 155 primary care patients with two or more uncontrolled MCC (including cardiovascular disease, diabetes, obesity, or depression) and who participated in a care planning intervention. Intervention/Instrument: Patients used an enhanced care planning tool, My Own Health Report (MOHR), to screen for health behavior, mental health, and social needs. They also received help from a patient navigator to create a care plan in MOHR for one or more of their needs. Outcome Measures: MOHR needs assessment, MOHR care plan topics, and EQ5D health-related quality of life (higher EQ5D scores indicates worse quality of life). Results: Ninety-two patients chose to create care plans. Of these, 40 endorsed mental health needs but only one created a mental health care plan. Sixty-nine patients endorsed health behavior needs and 64 created health behavior care plans. Thirty-one patients endorsed social needs and five created a social care plan. Lower HRQOL was associated with a higher likelihood of a mental health need (OR=2.19, p=0.002) or social need (OR=3.05, p