Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot

Abstract

BackgroundOlder adults with complex care needs face trade-offs in determining the right course of treatment. The Centers for Medicare and Medicaid Services identified ‘Care is personalized and aligned with patient’s goals’ as a key meaningful measures category, yet existing quality measures typically assess disease-specific care and may not effectively evaluate what is most important to older adults and family members. Measures based on individualised goals and goal-based outcomes have been proposed as an alternative but are not routinely assessed or implemented.ObjectivesWe tested two approaches to assessing goal-based outcomes that allow individuals to set goals based on their own priorities and measure progress—(1) goal attainment scaling and (2) existing, validated patient-reported outcome measures (PROM).MethodsA prospective cohort study of feasibility in seven sites (33 clinicians) of the two approaches with 229 individuals. We calculated performance on a measure of achievement of individually identified goals.ResultsBoth approaches were successfully implemented in a non-randomly selected population, and a goal-based outcome could be calculated for 189 (82%) of participants. Most individuals met their goal-based outcome (73%) with no statistical difference between the goal attainment scaling approach (74%) and the patient-reported outcomes approach (70%). Goals were heterogeneous ranging from participating in activities, health management, independence and physical health. Clinicians chose to use goal attainment scaling (n=184, 80%) more often than PROMs (n=49, 20%) and rated the goal attainment scaling approach as useful for providing patient care.ConclusionGoal-based outcomes have the potential to both improve the way healthcare is provided and fill a critical gap in value-based payment.

A scoping review of person and family engagement in the context of multiple chronic conditions

“…The patient portal not only allows patients to view sections of their electronic medical record, perform health management tasks (e.g., schedule visits, pay bills, fill prescriptions), access education, and interact with clinicians using secure messaging but may also be used to collect patient‐reported health information that could facilitate patients proactive reporting of goals. Although emerging evidence speaks to the feasibility of deploying goal‐oriented care in practice, 39,46,52 there are practical challenges regarding the specification of goals and their measurement and interpretation. Moving toward goal‐based care will require not only attending to the elicitation and respect of individual goals but collaboration among medical and community‐based organizations, as health care alone cannot facilitate individuals achieving goals in which health is just one component (e.g., as given in Giovannetti et al, 46 “to move to an assisted living facility in the next three months”).…”

Use of standardized brief geriatric evaluation compared with routine care in general practice for preventing functional decline: a pragmatic cluster-randomized trial

“…More recent approaches that promote goaloriented care and assess individual goal attainment are promising. [41][42][43] On the other hand, studies in the field of multimorbidity have shown contrasting results on quality of life, even if a goaloriented, patient-centred approach was used. 37…”

Achieving patient priorities: an alternative to patient-reported outcome measures (PROMs) for promoting patient-centred care

“…These quality metrics would evaluate the process for collaboratively identifying patient goals and care preferences and the degree to which patient goals are attained. In the current issue of BMJ Quality and Safety, Giovannetti et al 17 describe the results of an innovative study that evaluated the feasibility of two different approaches to developing quality measures of goals-based care. The study assessed the implementation of these measures into diverse clinical settings and the subsequent interpretability and usefulness of the measures based on the data generated from either approach.…”

“…As Giovannetti and colleagues describe, the key gap in evaluating goals-based care is the presence of measures for setting and documenting goals as well as tracking goal progress and attainment. 17 In routine care, patient goals and care preferences are infrequently and haphazardly written and communicated, often conflicting, and typically focus on end-of-life care or chronic disease biomarkers. [18][19][20][21] To address these gaps, the authors adapted goal attainment scaling, a reliable and valid approach for measuring goal setting and goal attainment in research studies.…”

“…They later discussed and then individually rated the degree of goal attainment. The other approach evaluated by Giovannetti and colleagues 17 is the use of patient-reported outcome measures (PROMs), which are often used to measure specific domains (eg, mood, functioning, symptoms and so on) of health-related quality of life. [24][25][26] In their study, Giovannetti et al 17 asked patients and clinicians to jointly set a goal and then select a PROM that best matches that goal.…”