A Mixed-Methods Usability Pilot of a Value-Goal Elicitation Tool in the Inpatient Setting for Older Adults Anticipating Post-Acute Care

Abstract

Age-Friendly Health Systems (AFHS) emphasize aligning care with "What Matters" most to older adults. Hospitalization represents a critical period where value-based goals could shape key decisions about post-acute care transitions. However, few tools designed for eliciting such goals have been adapted for use in the inpatient setting, where the acute nature of care poses unique challenges. This mixed-methods study evaluates the usability of the Health Priorities Primer Tool (HPPT) in older hospitalized adults who anticipate needing post-acute care, aiming to identify necessary adaptations for the inpatient setting. We conducted interviews, observations, and surveys with older hospitalized patients to understand their experiences using the HPPT. We combined thematic analysis with descriptive statistics to analyze the data. Of the 26 participants, 73% expressed positive views toward completing a value-goal elicitation tool while hospitalized, with 53% supporting the HPPT. For open-ended questions, many participants shared broad goals like "getting better" without providing specific outcomes to achieve. For pre-determined checkbox-based questions, some participants found response options overwhelming or irrelevant. Most participants (85%) preferred facilitated administration of the tool over self-administration. Key Recommendations include simplifying the tool's format, personalizing content, and improving framing about how and why values and goals would be used. Our findings highlight the potential usability of value-goal elicitation tools like HPPT to guide post-acute care planning for hospitalized adults. Key adaptations, including facilitated administration and clinician involvement, may enhance usability. Early user engagement and tailoring are essential for successful implementation in busy inpatient settings.

Keywords: Veterans Health Administration; age-friendly healthcare system; care transitions; decisional-tool; discharge planning; geriatrics.