TY - JOUR
T1 - Engaging Stakeholders to Inform Clinical Practice Guidelines That Address Multiple Chronic Conditions
AU - Bennett, Wendy L.
AU - Robbins, Craig W.
AU - Bayliss, Elizabeth A.
AU - Wilson, Renee
AU - Tabano, Heather
AU - Mularski, Richard A.
AU - Chan, Wiley V.
AU - Puhan, Milo
AU - Yu, Tsung
AU - Leff, Bruce
AU - Li, Tianjing
AU - Dickersin, Kay
AU - Glover, Carol
AU - Maslow, Katie
AU - Armacost, Karen
AU - Mintz, Suzanne
AU - Boyd, Cynthia M.
N1 - Funding Information:
Research reported in this article was funded through a Patient-Centered Outcomes Research Institute(PCORI) Award (ME-1310-07619). The statements presented in this article are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee.
Publisher Copyright:
© 2017, Society of General Internal Medicine.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Background: Having more than one chronic condition is common and is associated with greater health care utilization, higher medication burden and complexity of treatment. However, clinical practice guidelines (CPGs) do not routinely address the balance between harms and benefits of treatments for people with multiple chronic conditions (MCCs). Objective: To partner with the Kaiser Permanente Integrated Cardiovascular Health (ICVH) program to engage multiple stakeholders in a mixed-methods approach in order to: 1) identify two high-priority clinical questions related to MCCs, and 2) understand patients’ and family caregivers’ perceptions of meaningful outcomes to inform benefit/harm assessments for these two high-priority questions. These clinical questions and outcomes will be used to inform CPG recommendations for people with MCCs. Design and Participants: The ICVH program provided 130 topics rank-ordered by the potential for finding evidence that would change clinical recommendations regarding the topic. We used a modified Delphi method to identify and reword topics into questions relevant to people with MCCs. We used two sets of focus groups (n = 27) to elicit patient and caregiver perspectives on two important research questions and relevant patient-important outcomes on benefit/harm balance for people with MCCs. Key Results: Co-investigators, patients and caregivers identified “optimal blood pressure goals” and “diabetes medication management” as important clinical topics for CPGs related to people with MCCs. Stakeholders identified a list of relevant outcomes to be addressed in future CPG development including 1) physical function and energy, 2) emotional health and well-being, 3) avoidance of treatment burden, side effects and risks, 4) interaction with providers and health care system, and 5) prevention of adverse long-term health outcomes. Conclusions: Through the application of a mixed-methods process, we identified the questions regarding optimal blood pressure goals and diabetes medication management, along with related patient-centered outcomes, to inform novel evidence syntheses for those with MCCs. This study provides the lessons learned and a generalizable process for CPG developers to engage patient and caregivers in priority-setting for the translation of evidence into future CPGs. Ultimately, engaging patient and stakeholders around MCCs could improve the relevance of CPGs for the care of people with MCCs.
AB - Background: Having more than one chronic condition is common and is associated with greater health care utilization, higher medication burden and complexity of treatment. However, clinical practice guidelines (CPGs) do not routinely address the balance between harms and benefits of treatments for people with multiple chronic conditions (MCCs). Objective: To partner with the Kaiser Permanente Integrated Cardiovascular Health (ICVH) program to engage multiple stakeholders in a mixed-methods approach in order to: 1) identify two high-priority clinical questions related to MCCs, and 2) understand patients’ and family caregivers’ perceptions of meaningful outcomes to inform benefit/harm assessments for these two high-priority questions. These clinical questions and outcomes will be used to inform CPG recommendations for people with MCCs. Design and Participants: The ICVH program provided 130 topics rank-ordered by the potential for finding evidence that would change clinical recommendations regarding the topic. We used a modified Delphi method to identify and reword topics into questions relevant to people with MCCs. We used two sets of focus groups (n = 27) to elicit patient and caregiver perspectives on two important research questions and relevant patient-important outcomes on benefit/harm balance for people with MCCs. Key Results: Co-investigators, patients and caregivers identified “optimal blood pressure goals” and “diabetes medication management” as important clinical topics for CPGs related to people with MCCs. Stakeholders identified a list of relevant outcomes to be addressed in future CPG development including 1) physical function and energy, 2) emotional health and well-being, 3) avoidance of treatment burden, side effects and risks, 4) interaction with providers and health care system, and 5) prevention of adverse long-term health outcomes. Conclusions: Through the application of a mixed-methods process, we identified the questions regarding optimal blood pressure goals and diabetes medication management, along with related patient-centered outcomes, to inform novel evidence syntheses for those with MCCs. This study provides the lessons learned and a generalizable process for CPG developers to engage patient and caregivers in priority-setting for the translation of evidence into future CPGs. Ultimately, engaging patient and stakeholders around MCCs could improve the relevance of CPGs for the care of people with MCCs.
KW - multiple chronic conditions
KW - qualitative research
KW - stakeholder engagement
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U2 - 10.1007/s11606-017-4039-5
DO - 10.1007/s11606-017-4039-5
M3 - Article
C2 - 28349409
AN - SCOPUS:85016097810
SN - 0884-8734
VL - 32
SP - 883
EP - 890
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 8
ER -