# Integrating personal values into primary care for Veterans with multimorbidity

> **NIH VA IK2** · VA PUGET SOUND HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: Veterans with > 2 chronic conditions (multimorbidity) comprise almost 50% of patients in the
Veterans Health Administration (VA). Primary care providers (PCPs) provide over 90% of outpatient VA care for
the most complex, high-risk Veterans with multimorbidity. At present, these patients and their PCPs must juggle
numerous healthcare and psychosocial needs with limited time and resources, both in clinic and in self-
management at home. Patients and PCPs also make decisions about what care needs to prioritize without
adequate guidance from clinical practice guidelines, many of which focus on single-disease processes. Patients
and PCPs often disagree about what is most important; patients prioritize symptoms, while PCPs emphasize
prognosis. Studies suggest that helping patients and PCPs communicate about what is most meaningful in life
to patients (i.e., “personal values”) and align preferred health outcomes (i.e., “health priorities”) streamlines care,
lowers treatment burden, and reduces unwanted interventions. To date, no study has clarified the circumstances
in which personal values can guide health decisions or developed an approach linking personal values and
actionable clinical care that helps navigate tensions between conflicting priorities. To address these gaps, this
CDA will integrate a patient’s personal values into high-quality primary care by developing and testing an
intervention (“Vet-Align”), a values-based approach to care for higher-risk Veterans with multimorbidity.
Significance/Impact: This CDA advances VA and HSR&D priorities by improving patient-centric primary care
and addressing what matters most to Veterans. This has long-term implications, including improving the
specificity and personalization of VA quality metrics, advancing universal health outcomes, promoting patient
engagement and adherence in care, and reducing waste and harm from unwanted or inappropriate care.
Innovation: This CDA develops and tests a novel intervention using patient values and priorities to align primary
care planning and delivery. This CDA will advance multimorbidity care and draws on novel methods including
human-centered design (HCD) and multi-criteria decision analysis (MCDA), a participatory decision process.
Specific Aims: 1) Understand how and when Veterans with multimorbidity connect values, health, and
healthcare, to clarify the life and health circumstances where patient values directly influence PCP-patient care
planning and self-management decisions; 2) Examine how VA ambulatory quality metrics align with and support
patient priorities and values, to develop guidance for aligning disease-oriented quality metrics with patient-
centered priorities of Veterans within a personal values-based care delivery model; 3) Refine and pilot test the
acceptability and feasibility of Vet-Align, a values-based intervention for Veterans with multimorbidity, including
tools and workflows for VA primary care to translate patient values into a...

## Key facts

- **NIH application ID:** 10771964
- **Project number:** 5IK2HX003462-02
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Linnaea Schuttner
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-01-01 → 2027-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10771964

## Citation

> US National Institutes of Health, RePORTER application 10771964, Integrating personal values into primary care for Veterans with multimorbidity (5IK2HX003462-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10771964. Licensed CC0.

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