Are we measuring what matters to older people?

Conroy, Simon; Oppen, James David van

doi:10.1016/s2666-7568(23)00084-3

Cited by 8 publications

(9 citation statements)

References 26 publications

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Section: Discussionmentioning

confidence: 99%

“…The use of GAS aligns with the growing consensus regarding the need for PROMs in healthcare settings that interface with frailer, older people so that what matters most to them is measured [ 40 ]. Prior trials of interventions in this population favour traditional measures that are routinely captured and well understood, such as hospital admissions and functional status [ 40 ]. Recent guidance from the US Food and Drug Administration [ 41 ] advocates for measures, such as GAS, to be used to incorporate the patient’s voice in regulatory decision-making on drug development.…”

Section: Discussionmentioning

confidence: 99%

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Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure

Logan,

Viecelli,

Pascoe

et al. 2024

J Patient Rep Outcomes

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Background Goals generated by Goal Attainment Scaling (GAS) can be used as an outcome measure to promote person-centred research and care. There are no training packages which support its use outside of the rehabilitation discipline. This paper describes the development and evaluation of a training package to support the implementation of GAS as an outcome measure in healthcare research. The training package consisted of classroom teaching, a training manual for self-directed learning, one-on-one simulation and hot reviews. It was developed for the GOAL Trial, a randomised controlled trial assessing a Comprehensive Geriatric Assessment’s effectiveness in enabling frail older people living with chronic kidney disease to attain their goals. Training participants were invited to complete pre- and post-training online evaluation surveys. Results Forty-two healthcare professionals attended an initial online classroom teaching, with 27 proceeding to administer GAS to GOAL Trial patients. Response rates for the online pre- and post-training surveys were 95% and 72%, respectively. Prior to training, only 15% of participants reported being able to appropriately scale and troubleshoot GAS goals. Post-training this was 92%. There was 100% participant satisfaction for the training manual, one-on-one simulation, and hot reviews. Conclusions This training package helps ensure healthcare professionals administering GAS have adequate knowledge and skills. It has the potential for adoption as a guide to support the implementation of GAS by other researchers seeking to embrace persont-centred principles in their work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure

Logan,

Viecelli,

Pascoe

et al. 2024

J Patient Rep Outcomes

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“…While our understanding of frailty has progressed, there remains disagreement on the conceptualisation of frailty among healthcare practitioners and how frailty is identified. 2 6 7 17 Moreover, as highlighted by Conroy and van Oppen, 8 many outcomes that matter to older people with frailty are not routinely collected by the NHS. Despite these issues, people with complex conditions need personalised support.…”

Section: Discussionmentioning

confidence: 99%

“…There is debate on how useful the electronic frailty index is, which was recommended for identifying people who are frail, 6 7 how frailty is conceptualised by medical practitioners 6 and what outcome measures are suitable to monitor impact of frailty on a person. 8 Nevertheless, local frailty strategies are being put into action in the English NHS. 9 …”

Section: Introductionmentioning

confidence: 99%

Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure

Polley,

Barker,

Collaco

et al. 2024

BMJ Open Qual

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IntroductionMeasure Yourself Concerns and Wellbeing is a validated person-centred outcome measure, piloted as a core monitoring tool to understand what matters to people living with frailty in Gloucestershire. This paper describes the acceptability of MYCaW used in this setting, and the development of a framework for analysing personalised concerns from people living with frailty.MethodsMYCaW was implemented in the Complex Care at Home service and South Cotswold Frailty Service from November 2020 onwards. MYCaW was completed at the person’s first meeting with a community matron and then 3 months later. Nineteen staff completed an anonymous survey to provide feedback on the acceptability of the tool. A framework of concerns bespoke to people living with frailty was created via iterative rounds of independent coding of 989 concerns from 526 people. The inter-rater reliability of the framework was determined by using the Cronbach alpha test.ResultsMYCaW was simple to use and helped health professionals’ discussions to be patient focused. A pictorial scale accompanying the Numerical Rating Scale was developed and tested to help people engage with scoring their concerns and well-being more easily. A framework of concerns from people living with frailty was produced with five main supercategories: Mental and Emotional Concerns; Physical Concerns; Healthcare and Service Provision Concerns, Concerns with General Health and Well-being and Practical Concerns. Inter-rater reliability was kappa=0.905.ConclusionsMYCaW was acceptable as a core monitoring tool for people living with frailty and enabled a systematic approach to opening ‘What Matters to Me’ conversations. The personalised data generated valuable insights into how the frailty services positively impacted the outcomes for people living with frailty. The coding framework demonstrated a wide range of concerns—many linked to inequalities and not identified on existing outcome measures recommended for people living with frailty.

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“…Using PROMs rather than, or in addition to, health care utilization outcomes to measure the quality of care after an ED visit centers care on patients’ needs 16,17 . Particularly after an acute health care event such as an ED visit, PROM assessments among older ED patients are critical given prior quantitative and qualitative work highlighting the population's unique prioritization of outcomes including functional status, disability, and QoL 18–20 . Barriers and best practices to PROM use have been described for the broader emergency care or hospital populations in existing reviews 21,22 ; however, a comprehensive review of PROM use in the older adult population following emergency care is missing.…”

Section: Introductionmentioning

confidence: 99%

Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

Gettel,

Galske,

Sather

et al. 2024

Academic Emergency Medicine

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BackgroundPatient‐reported outcome measures (PROMs) are gaining favor in clinical and research settings given their ability to capture a patient's symptom burden, functional status, and quality of life. Our objective in this systematic review was to summarize studies including PROMs assessed among older adults (age ≥ 65 years) after seeking emergency care.MethodsWith the assistance of a medical librarian, we searched Ovid MEDLINE, PubMed, Embase, CINAHL, Web of Science‐Core Collection, and Cochrane CENTRAL from inception through June 2023 for studies in which older adult ED patients had PROMs assessed in the post–emergency care time period. Independent reviewers performed title/abstract review, full‐text screening, data extraction, study characteristic summarization, and risk‐of‐bias (RoB) assessments.ResultsOur search strategy yielded 5153 studies of which 56 met study inclusion criteria. Within included studies, 304 unique PROM assessments were performed at varying time points after the ED visit, including 61 unique PROMs. The most commonly measured domain was physical function, assessed within the majority of studies (47/56; 84%), with measures including PROMs such as Katz activities of daily living (ADLs), instrumental ADLs, and the Barthel Index. PROMs were most frequently assessed at 1–3 months after an ED visit (113/304; 37%), greater than 6 months (91/304; 30%), and 4–6 months (88/304; 29%), with very few PROMs assessed within 1 month of the ED visit (12/304; 4%). Of the 16 interventional studies, two were determined to have a low RoB, four had moderate RoB, nine had high RoB, and one had insufficient information. Of the 40 observational studies, 10 were determined to be of good quality, 20 of moderate quality, and 10 of poor quality.ConclusionsPROM assessments among older adults following an ED visit frequently measured physical function, with very few assessments occurring within the first 1 month after an ED visit.

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Are we measuring what matters to older people?

Cited by 8 publications

References 26 publications

Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure

Training healthcare professionals to administer Goal Attainment Scaling as an outcome measure

Developing a framework of concerns from people living with frailty, for the Measure Yourself Concerns and Wellbeing (MYCaW) person-centred outcome measure

Patient‐reported outcome measure use among older adults after emergency department care: A systematic review

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