Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot
| Autor: | Angelia M Bowman, Catherine A Clair, Sarah Hudson Scholle, David B. Reuben, Lee A. Jennings, Erin R. Giovannetti, Shana F Sandberg |
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| Rok vydání: | 2019 |
| Předmět: |
Gerontology
education.field_of_study Health management system business.industry Health Policy media_common.quotation_subject Population Prom Medicare Outcome (game theory) United States Goal Attainment Scaling Health care Outcome Assessment Health Care Medicine Humans Quality (business) Family Prospective Studies business education Medicaid Goals media_common Aged |
| Zdroj: | BMJ qualitysafety. 30(2) |
| ISSN: | 2044-5423 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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