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.
- performance measures
- shared decision making
- patient-centred care
- quality measurement
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Contributors ERG was the study PI and led the analysis and writing of the manuscript. CAC was responsible for qualitative analysis and contributed to writing of the manuscript. LAJ, DBR and SFS were coinvestigators and contributed to the design of the study and writing of the manuscript. SHS was an advisor on the project and provided substantial feedback on the manuscript.
Funding This work was funded by The John A. Hartford Foundation and The SCAN Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study intervention was implemented at each site as a quality improvement project. Secondary analysis of the quality improvement data was reviewed and approved by the Chesapeake Institutional Review Board (Pro00017844).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. Due to the terms of agreement with the participating organisations no data are available at this time.