Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study

作     者：Samper-Ternent, Rafael Razjouyan, Javad Dindo, Lilian Halaszynski, Jaime Silva, Jennifer Fried, Terri Naik, Aanand D. 

作者机构：UTHlth Houston Dept Management Policy & Community Hlth 1200 Pressler StRoom E905 Houston TX 77030 USA UTHlth Houston Inst Aging Houston TX USA Michael E DeBakey VA Med Ctr VA Hlth Serv Res & Dev Serv Ctr Innovat Qual Effectiveness & Safety Houston TX USA Baylor Coll Med Dept Med Houston TX USA VA Off Res & Dev Big Data Scientist Training Enhancement Program BD Washington DC USA Butler VA Hlth Care Syst Social Work Serv Butler PA USA Dept Vet Affairs VA Natl Social Work Program Care Management & Social Work Serv Off Patient Care Serv Washington DC USA Yale Univ Sch Med Dept Med New Haven CT USA Connecticut Vet Adm Hlth Syst West Haven CT USA 

出 版 物：《JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION》 (美国医务主管人协会志)

年 卷 期：2024年第25卷第5期

页      面：751-756页

核心收录：

学科分类：12[管理学] 1204[管理学-公共管理] 120402[管理学-社会医学与卫生事业管理(可授管理学、医学学位)] 1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 10[医学] 

基　　金：Office of Rural Health, ORH Center for Innovations in Quality, Effectiveness and Safety, IQuESt Veterans Administration Medical Center, Yale School of Medicine, VAMC VA HSRD, (CIN 13-413) National Heart, Lung, and Blood Institute, NHLBI, (5K25HL152006) National Heart, Lung, and Blood Institute, NHLBI 

主　　题：Long-term services and supports patient priorities veterans older adults 

摘      要：Objectives: Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient s priorities. This study examined the impact of the PPC approach on longterm service and support (LTSS) use among veterans. Design: Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. Setting and Participants: Fifty-six social workers in 5 Veterans Health Administration (VHA) sites trained in PPC in 2018,143 veterans who used the PPC approach, and 286 matched veterans who did not use the PPC approach. Methods: Veterans with health priorities identified through the PPC approach were the intervention group (n = 143). The usual care group included propensity-matched veterans evaluated by the same social workers in the same period who did not participate in PPC (n = 286). The visit with the social worker was the index date. We examined LTSS use, emergency department (ED), and urgent care visits, 12 months before and after this date for both groups. Electronic medical record notes were extracted with a validated natural language processing algorithm (84% sensitivity, 95% specificity, and 92% accuracy). Results: Most participants were white men, mean age was 76, and 30% were frail. LTSS use was 48% higher in the PPC group compared with the usual care group [odds ratio (OR), 1.48;95% CI, 1.00-2.18;P = .05]. Among those who lived 2 years after the index date, new LTSS use was higher (OR, 1.69;95% CI, 1.04-2.76;P = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70;95% CI, 1.06-2.74;P = .028). PPC was not associated with higher ED or urgent care use. Conclusions and Implications: PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfra