Identifying Implementation Needs and Developing Strategies to Optimize Integration of Patient Priorities Care in Primary Care: A Qualitative Formative Evaluation of Two Study Sites.

Abstract

Patient priorities care (PPC) was developed to focus care on outcomes most important to multimorbid older adults, rather than single-disease clinical practice guidelines. In PPC, a care team member conducts a health priorities identification (HPI) conversation with a patient, and the resulting HPI note is shared with the patient's provider to guide priorities-aligned care. Primary care clinics and patients may benefit from PPC, but successful implementation relies on assessing features of the sites and end users to inform implementation strategies. Conduct a formative evaluation of two sites using in-depth qualitative interviews. Identify implementation needs and develop strategies to optimize the integration of PPC. Formative evaluation was guided by the i-PARIHS implementation framework. 28 primary care clinicians sampled from two VA healthcare systems completed telephone interviews. Semi-structured interviews elicited implementation needs related to an upcoming PPC implementation trial. Interviews were recorded, transcribed, coded using a mixed inductive and deductive approach, and thematically analyzed. Analysis informed strategies to facilitate the implementation of PPC. Thematic analysis revealed two themes and related subthemes: (1) Enhance potential usability of the patient health priorities identification (HPI) note and PPC process, with focus on the timing of the HPI call, the content and placement of the resulting HPI note, and modification of materials to address the time burden associated with providing and documenting priorities-aligned care; and (2) Address contextual issues related to clinician participation, including garnering leadership support, allaying concerns about performance metrics, and modifying clinician training to optimize integration into existing workflows. Within each theme, we present strategies devised to address implementation needs. The formative evaluation identified implementation needs, which informed the development of strategies ranging from specific modifications to multicomponent strategies to facilitate the implementation of PPC into routine primary care. Future research will evaluate the adoption of these strategies.