MedStar Health Measures Goal-Based Outcomes Among Older Disabled Patients

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Collaborative research from MedStar Health Research Institute’s Health Economics and Aging Research team along with other researchers sought to assess goal-based outcomes that allow individuals to set goals based on their own priorities and measure progress.  "Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot" was published in BMJ Quality and Safety.

The study used seven clinical practices, with 33 clinicians participating, that served an older adult, functionally disabled population and existing process for eliciting patient centered goals. Each of the seven sites were asked to identify potential participants from their existing cases who were over 50 years old with either activity of daily living (ADL) or instrumental ADL impairments along with caregivers. 

For individuals with cognitive impairment, clinicians were encouraged to set goals with the patient if possible and engage the caregiver. For individuals without cognitive impairment, clinicians were encouraged to set goals with the patient but set goals with the caregiver (alone or in tandem with the patient) if they were normally part of the clinical encounter. Participants    and    clinicians    used      existing    approaches for eliciting patient-centered goals and then used either the goal attainment scaling or prioritized patient-reported outcome measures approach to measure goal achievement.  

Across the seven sites that implemented the goal-setting intervention, there were 193 patients alone, 30 patient and caregiver dyads, and 6 caregivers alone for a total of 229 participants. All study participants set at least one goal and 31 participants had more than one goal for a total of 263 goals. Seventeen of the 33 participating clinicians responded to the usability questions (response rate 51%).  On a 10-point scale (1–10), clinicians rated usability of goal attainment scaling. as high on all three domains on average: determining which services and supports to provide, helping patients achieve their goals and helping patients track their progress. 

Among goal attainment scaling participants with follow-up data, 74% met at least one goal. 12% revised their goal, or expected outcome, over the 6-month period. Sometimes goal revision occurred when participants achieved a goal and set new ones; in other cases, participants decided to revise their goal because they were not making progress and wanted to set a more realistic goal, or they preferred to work on a different goal. 

Among the prioritized patient-reported outcome measures participants with follow-up data, 70% achieved their goal, with 5 participants revising their goal over the study period. The rate of goal achievement was not significantly different between the two approaches. In most cases (92%), the individual and clinicians’ rating of goal achievement matched; however, there was a minority of cases where individuals rated their goal attainment higher than the clinicians’ ratings and vice versa. 

The study team concludes that using structured approaches to goal-based outcomes for older adults with complex care needs could be feasible in clinical care and a promising approach for quality measurement that could lead to improvements in person-centered care delivery for this population.   

BMJ Quality and Safety. 2020. DOI: 10.1136/bmjqs-2020-012244

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