A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals

摘要

Background: Goal Attainment Scaling (GAS) is an individualized goal-setting and measurement approach that is useful for patients with multiple, individualized health problems, such as those served by geriatric day hospitals (GDHs) and other specialized geriatric programmes. Purpose: To assess the feasibility and utility of GAS in a multi-site study of six GDH affiliated with the Regional Geriatric Programmes of Ontario. Method: Individualized GAS guides were developed for 15 consecutively admitted patients at each site [total n = 90; mean age: 76.2 SD 8.3; 58.9% female; mean attendances: 24.0 SD 10.3]. Staff members (n = 39) were surveyed on their experience with GAS. Results: Mean goals/patient ranged across sites from 2.1 to 4.3. Mean GAS discharge score was 52.3 SD 8.7, close to the theoretically expected values of 50 SD 10. Common goals included mobility, community reintegration, basic and instrumental activities of daily living, medical issues, cognition/communication, and home safety. Estimated mean time to develop a GAS guide ranged across sites from 15.3 to 43.8 min. Conclusion: Clients were often involved in goal setting; family involvement was less frequent. The staff survey identified challenges and benefits regarding the use of GAS. Study results are being used to inform a more consistent approach to the clinical and research use of GAS in GDH. Implications for Rehabilitation The geriatric day hospital (GDH) has had a long history as one element of a comprehensive system of specialized geriatric services with potential advantages including ongoing treatment and rehabilitation from an interdisciplinary team. Despite this history, the evidence for the effectiveness of GDHs in rehabilitation of older persons has been equivocal. We found that Goal Attainment Scaling (GAS) was able to detect clinically relevant change in this setting which can aid in demonstrating evidence for the utility and impact of GDHs. GAS was feasible in this setting and clinicians felt that GAS may have an effect on speeding up discharge, as a result of having a clearer focus on outcomes that are desired for each patient. Clinicians felt the involvement of clients and families in goals settings resulted in more meaningful outcomes for clients and GAS aided in identifying highly individual outcomes such as quality of life and community integration that are routinely difficult to measure with standardized tools.