Erin R Giovannetti 1 , Catherine A Clair 2 , Lee A Jennings 3 , Shana F Sandberg 4 , Angelia Bowman 2 , David B Reuben 5 , Sarah H Scholle 2 Show Affiliations »
Abstract
BACKGROUND: Older 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. OBJECTIVES: We 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). METHODS: A 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. RESULTS: Both 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. CONCLUSION: Goal-based outcomes have the potential to both improve the way healthcare is provided and fill a critical gap in value-based payment. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
BACKGROUND: Older 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. OBJECTIVES: We 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). METHODS: A 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. RESULTS: Both 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. CONCLUSION: Goal-based outcomes have the potential to both improve the way healthcare is provided and fill a critical gap in value-based payment. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Species
Keywords:
patient-centred care; performance measures; quality measurement; shared decision making
Year: 2020
PMID： 33037142 DOI： 10.1136/bmjqs-2019-010742
Source DB: PubMed Journal: BMJ Qual Saf ISSN： 2044-5415 Impact factor: 7.035