Dr. Mary Tinetti
by Crystal Gwizdala
Mary E. Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics), is the co-creator of Patient Priorities Care. This age-friendly approach focuses healthcare and decision-making on what matters most to a person — their own health priorities. Patient Priorities Care is suitable for any patient, but especially for older adults with complex or multiple problems.
In collaboration with The Arnold P. Gold Foundation, this partnership offers evidence-based resources to help health professionals incorporate this patient-centered approach into their work. Gold Partners Council members now have access to four Patient Priorities Care tools.
We are pleased to share this Q&A with Dr. Tinetti to learn more.
How did you get the idea to create Patient Priorities Care?
“After decades as a geriatrician, I knew that treating one disease at a time didn’t make sense. Most older adults have multiple chronic conditions and variable life circumstances. Treating multiple diseases together became at the very least burdensome, but also potentially harmful. Working with a national group of older adults, care partners, and health professionals, it became evident that care should align with what matters most to each patient, their health priorities.”
What are the major challenges to care that make it difficult to put the patient’s priorities first?
“Healthcare is disease-centered rather than patient-centered. It is structured and paid for around individual diseases and procedures for those diseases, which is often counterproductive to what’s most important for people with multiple conditions and complex life situations.”
How has Patient Priorities Care been working to address those challenges?
“We’re moving the conversation from the disease to what matters to the individual. The conversation changes from ‘you need this intervention for this disease’ to ‘knowing all of your health conditions, your overall health status, your life and what’s most important to you, I suggest we try this intervention.’
“We’re also working to shift the conversation at the health systems level, and eventually at the level of payment and measurement of quality. We’re getting evidence from health systems to support that moving from disease-based decision-making to patient priorities-aligned care results in less unwanted care, more wanted care, and less utilization. There are also efforts at incorporating this approach to decision-making into the training of health professionals of all types, which is particularly important because we tend to practice what we are trained throughout our careers.”
How did the Patient Priorities Care team develop these set of tools?
“The original approach was based on principles from behavioral psychology. We began with values such as independence or relationships which remain stable over life and health changes, and translating these into specific, actionable, and realistic goals needed for decision-making. For example, a goal could be to cook dinner for their grandchildren once a week. We then identify the most bothersome health problem, such as shortness of breath, which they feel is impeding their goal. Their top priority, what a person most wants their health care to focus on, brings these together. For example, ‘I want to be less short of breath so I can cook dinner for my grandchildren once a week.’ Our Identifying Priorities Quick Guide is the result of years of testing and fine-tuning the process to simplify priorities identification.”
“We created the My Health Priorities website for older adults, independently or with care partners, to identify their health priorities. When they’re finished, the site generates a one-page summary they can bring to health care appointments. The site is available in Spanish, and soon in Chinese and Arabic. We also have a paper version of the website coming soon for those who don’t have access to a computer or prefer to do it by hand.”
“To assist health professionals in translating priorities into decision-making and care, the Aligning Care Quick Guide offers tips, conversation starters, and strategies. It focuses on interventions that address the medical, social, environmental, and other factors hindering goal achievement.
“For quick tips on identifying priorities or aligning care on the go, use our Pocket Card. It also has strategies and QR codes to more resources.”
What’s one thing a health professional can do today to start trying Patient Priorities Care?
“Start with the Identifying Priorities Quick Guide. It gives you probes to identify individual’s values, goals, preferences, and top priority. Start with one patient, then another. It may feel uncomfortable or unfamiliar at first. Focus on treating diseases through the lens of what matters most to the individual by using the tips and scripts in the Aligning Care Quick Guide. It gets easier and more natural as you do it. If you’re willing to stick with it, you can take care of complex older adults in a more simple, focused, and meaningful way.”
Can you share why you were interested in this collaboration with the Gold Foundation?
“I’ve long admired the Gold Foundation for the prestigious awards they give in humanism. To have a foundation so singularly focused on ensuring people get as person-centered care as possible reach out to us is such an honor. You never know the effect your work is going to have, who’s going to recognize it, and who’s going to be interested. The Gold Foundation is very special in terms of what their mission is. It helped give us a personal sense of credibility that we’re on the right path. It’s been wonderful being part of this work and being associated with the Gold Foundation.”
Thank you to Dr. Tinetti and Patient Priorities Care for this important work that helps advance humanism in healthcare.
The Gold Foundation has partnered with Patient Priorities Care to offer several tools to members of the Gold Partners Council, a group of schools and health systems that are champions of humanism in healthcare. Gold Partners Council members can access the PPC-Gold tools here.
If your institution is a Gold Partners Council member, reach out to your dean of student affairs or education or email Brianne Alcala at balcala@gold-foundation.org for the member password.
