How healthcare financialization shapes goal-concordant serious illness care in older adults
Funded Grant
Overview
Affiliation
View All
Overview
description
PROJECT SUMMARY/ABSTRACT Older adults with serious illness are at risk of receiving goal-discordant treatments that are not aligned with their preferences and values. Healthcare financialization, an understudied social force, plays an increasingly significant role in shaping goal-concordant serious illness care in the United States. There is a critical gap in understanding the mechanisms by which financialization affects the goal concordance of serious illness care for older adults. This study's objectives are to elucidate how financialization shapes goal-concordant serious illness care and using this data to develop institution-level strategies that ensure financialized health systems prioritize the provision of goal-concordant care and design feasible and acceptable hospital-level policies to improve goal-concordant serious illness care within the context of increasing financialization. This study will achieve its objectives through the following specific aims: Aim 1: Document mechanisms by which financialization shapes goal-concordant serious illness care for older adults and ways hospitals successfully balance financialization pressures with facilitating goal-concordant serious illness care. We will conduct an in- depth ethnographic interview study to understand how “inside-out” financialization shapes hospital culture and clinical practices in two geographic regions at two academic medical centers and two affiliated hospitals at each site (six sites total, n=180 interviews). “Inside-out” financialization refers to hospitals shifting toward prioritizing profit from non-healthcare-related activities rather than healthcare provision. Aim 2: Elicit physicians' perspectives and experiences of their ability to provide goal-concordant serious illness care for older adults at private equity-owned hospitals. To understand “outside-in” financialization, where financial actors assume hospital ownership, we will interview physicians who currently or have previously worked in a private equity-owned hospital (n=40). Aim 3: Develop hospital-level policy and best practice recommendations that maximize the benefits of financialization on physicians, patients, and caregivers while safe-guarding against potential negative impacts on goal-concordant serious illness care. We will synthesize Aim 1-2 findings with interviews with 20 policy experts and hospital leaders to develop a list of recommendations for hospital- level policies and best practices to respond to financialization's effects, which will be rated and refined through a 3-stage modified Delphi process involving 80 healthcare leaders, policymakers, policy experts, and physicians. The anticipated output is modifiable hospital-level policy and best practice recommendations to support the provision of goal-concordant serious illness care for older adults against the backdrop of financialization. This proposal is highly innovative as there are minimal studies—and no qualitative studies— exploring financialization's impacts on serious illness care. This proposal is significant because it will illuminate financialization's impacts on the goal concordance of serious illness care for older adults and pioneer policy recommendations for aligning care with patients' goals within the context of financialization.
