Novel Geriatric Care Model Aims to Align Treatment With Patients’ Personal Goals

A new model for geriatric care may improve the clinical experience for patients and medical providers alike by fostering a more collaborative, personalized approach. Investigators at Cleveland Clinic’s Center for Geriatric Medicine are researching how Patient Priorities Care (PPC) can help elderly patients achieve an optimal quality of life by focusing on each individual’s health goals and preferences.

Details of the study, which was conducted in collaboration with Yale University, were presented at the annual meeting of the American Geriatrics Society in May.

Individualized care

The PPC approach aims to align the management of geriatric patients with their own personal priorities. Rather than simply striving to meet predetermined benchmarks, clinicians are encouraged to focus on each patient’s core goals, values and care preferences, explains Ardeshir Hashmi, MD, Section Chief of Cleveland Clinic’s Center for Geriatric Medicine.

“Many of our patients have been living with chronic medical conditions for many years,” he says. “It may be time for us to reframe how we measure success when managing this population. If we allow lab values and statistics to solely lead the way, we may be missing something far more important: the patient’s happiness.”

Questions and answers

Cleveland Clinic was the first exclusively primary care site to test a PPC-aligned decision-making approach to managing geriatric patients with multiple chronic conditions. Approximately 150 patients at Lakewood Family Health Center were involved in the study, which required participants to undergo a telephone interview one week before their scheduled appointment with their primary care provider (PCP).

Investigators asked the patients to describe their priorities and life goals and explain any barriers that were preventing them from achieving their objectives. Participants were also asked to describe the things in their lives that were most important to them.

“We then went even deeper by asking the subjects to describe which aspects of their current care were helpful and which were burdensome,” he explains. “Specifically, we wanted to know what clinicians could do to help these patients feel better and reach their goals. Although healthcare often requires patients to do things they don’t necessarily want to do, we knew it was important to understand the trade-offs that each person was willing to make. Such insights can be invaluable when trying to help patients make informed decisions about their medical care.”

Mutual benefits

To keep communication open, the patients’ answers were relayed to their PCPs prior to their appointments.

“The PCPs themselves were going through a number of pandemic-related challenges at the time, including burnout and extra demands on their resources, so they found this more proactive approach to be incredibly liberating,” he says. “By the time the patient arrived, the clinician already had a sense of what was most important to them, which paved the way for a more meaningful conversation about their care.”

In addition, any questions and concerns a clinician may have were addressed in biweekly virtual huddles with Cleveland Clinic clinicians and PPC faculty. “By collaborating with one another, the PCPs found very smart ways to structure visits according to what mattered most to each individual patient. This, in turn, allowed the clinicians to work more efficiently and with greater precision,” says Dr. Hashmi.

Beginning in the fall, Dr. Hashmi’s team hopes to share the PPC method with more primary care practices. “Because PCPs have been so receptive to this approach, it is becoming a national movement,” he adds.

Data from the study, which is funded by a grant from the Donaghue Foundation, is undergoing validation and will be released later this year.