Patient priorities care (PPC) is a patient-centered 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 long-term service and support (LTSS) use among veterans. Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. 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. 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). 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; = .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; = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70; 95% CI, 1.06–2.74; = .028). PPC was not associated with higher ED or urgent care use. PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfrail veterans and those living longer. The PPC approach helps identify health priorities, including unmet needs for safe and independent living that LTSS can support.

中文翻译：

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患者优先护理可增加长期服务和支持的使用：倾向匹配队列研究

患者优先护理 (PPC) 是一种以患者为中心的方法，旨在通过确定患者的健康优先事项并与临床医生合作，根据患者的优先事项调整他们提供的护理，帮助患者实现对他们最重要的事情。本研究探讨了 PPC 方法对退伍军人使用长期服务和支持 (LTSS) 的影响。准实验研究检查接触 PPC 的退伍军人与未接触 PPC 的倾向匹配对照之间 LTSS 使用的差异，并调整协变量。2018 年，5 个退伍军人健康管理局 (VHA) 站点的 56 名社会工作者接受了 PPC 培训，其中 143 名退伍军人使用了 PPC 方法，286 名匹配的未使用 PPC 方法的退伍军人。通过 PPC 方法确定健康优先事项的退伍军人是干预组 (n = 143)。常规护理组包括由同一社会工作者在同一时期评估的倾向匹配退伍军人，但未参加 PPC (n = 286)。与社会工作者的拜访是索引日期。我们检查了两组患者在此日期前后 12 个月的 LTSS 使用情况、急诊室 (ED) 和紧急护理就诊情况。使用经过验证的自然语言处理算法提取电子病历笔记（灵敏度为 84%，特异性为 95%，准确度为 92%）。大多数参与者是白人男性，平均年龄为 76 岁，其中 30% 身体虚弱。与常规护理组相比，PPC 组的 LTSS 使用率高出 48%（优势比 [OR]，1.48；95% CI，1.00–2.18；= .05）。在索引日期后生活超过 2 年的人中，新使用 LTSS 的比例较高（OR，1.69；95% CI，1.04–2.76；= 0.036）。在非体弱个体中，PPC 组的 LTSS 使用率也较高（OR，1.70；95% CI，1.06–2.74；= 0.028）。PPC 与较高的 ED 或紧急护理使用无关。PPC 会导致这些退伍军人使用更多的 LTSS，但不会导致 ED 或紧急护理。体弱的退伍军人和寿命较长的人使用 LTSS 的比例更高。PPC 方法有助于确定健康优先事项，包括 LTSS 可以支持的安全和独立生活的未满足需求。