Research
Objectives
The Patient Priorities Care lab is focused on transforming decision making and delivery of care for older adults, their families, and clinicians. PPC stands on a foundation of healthcare aligned with patients’ health priorities. Health priorities are older adults’ values-based health outcome goals and care preferences. PPC places health priorities at the center of all communication and decision making among older adults, their families, and clinicians. The PPC lab tackles these research questions: (1) What are efficient and effective ways of identifying an older person’s health priorities? (2) How can we use technology in the processes of identifying health priorities and making decisions that align care with health priorities? (3) What are culturally appropriate adaptations that bring diverse older adult populations and their families into health priorities aligned decision making? (4) What are the measures that best represent personally-meaningful or clinically-important outcomes of the patient priorities care approach? (5) What are the best approaches to train clinicians, providers, families, and older adults in the processes of health priorities aligned communication and decision making? (6) How do we embed patient priorities care approaches into training programs of health professionals? (7) What are the alternative payment models, reimbursement practices, and business incentives that disseminate & sustain health priorities aligned communication and decision making?
Projects
Randomized Clinical Trial of PPC in Primary Care
We are conducting a randomized controlled trial (RCT) of priorities-aligned decision making within two Veterans Administration (VA) primary care networks, the Michael E. DeBakey Medical Center in Southeast Texas and VA Connecticut. This study hypothesizes that relative to usual care, health priorities aligned decision making will result in greater reductions in self-reported treatment burden, increased priorities-aligned use of home and community services, improved shared decision-making and reduced unnecessary medications and treatments. This study is funded by a VA MERIT award from the Veterans Administration Health Systems Research Service Line. Dr. Naik serves as a study MPI, Dr. Banks serves as a qualitative methodologist and Dr. Soni is a graduate research assistant.
PPC to deprescribe unnecessary medications for persons living with dementia
This pilot clinical trial adapts Patient Priorities Care to the context of deprescribing for persons living with dementia (PlwD). This study uses quantitative and qualitative methodologies to understand how priorities identification can facilitate communication and decisions around deprescribing of unwanted medications without increasing the incidence of adverse drug withdrawal events. This study is funded through the National Institute on Aging’s National Deprescribing Network. Dr. Naik and Dr. Holmes serve as multiple PIs. Drs. Samper-Ternent, Banks, and Giza at UTHealth Houston are Co-Is. Dr. Arney serves as a qualitative methodologist and Dr. Hysong serves as an industrial psychology consultant on the study. Dr. Soni is our graduate research assistant.
Patient Priorities Care for Hispanics with Dementia
This project seeks to culturally adapt the Patient Priorities Care approach for Hispanics living with dementia. The pilot study uses quantitative and qualitative approaches. PPC Lab research members obtain feedback on existing Patient Priorities Care materials from Hispanic older adults and their families. Feedback from our participants is informing the development of Patient Priorities Care flyers, manuals and digital resources culturally adapted for older Hispanic adults living in the United States. This project is led by Dr. Samper-Ternent.
Innovative Technology and Tools to Disseminate PPC
(1) The lab is updating the myhealthpriorities.org website and will embed products from the website into UT Physicians Epic. We will also culturally adapt the website for older Hispanic adults and families. Funding comes from the Nancy and Clive Runnells Foundation and the Pierce Runnells Foundation and the project is led by Dr. Naik. (2) The lab is adapting the health priorities aligned decision making approach for older adults considering surgery and other discrete medical interventions. The project activities include adaptations of our communication and decision making models, development of AI enabled chatbots, and pilot testing with older adults and their clinicians. Funding for this work comes from the UTHealth Institute on Aging and is led by Dr. Naik. Dr. Banks serves as a co-investigator. Dustan Brennan and his team in Information Technology Innovations and User Experience at the McGovern Medical School are integral partners in all of these projects.
Patient Priorities Care for Persons Living with Dementia
This is pilot study adapting the PPC approach to older persons living with dementia and their caregivers. The project is funded by the NIA IMPACT Collaboratory for pragmatic trials in dementia to Jennifer Carney, MD at Indiana University. Dr. Samper-Ternent is Site PI and Co-I, and Dr. Naik serves as a consultant. The project is a pilot clinical trial with enrollment at UT Physicians clinics serving older Hispanic populations.
