A person-centered approach to home and community-based services outcome measurement.
Matthew A Roberts, Brian H Abery
PMID 36817716WHAT IT FOUND
Current home and community-based service outcome measures mostly check if people hit standard benchmarks, not if they achieved the specific life goals they personally wanted.
The authors argue for tools that let individuals define and rate their own progress.
Key findings
01Existing outcome tools for home and community-based services are largely not person-centered, with only 36% of items in a recent review of 140 measures meeting criteria for assessing individual preferences.
02Person-centered measurement requires tools that track progress against goals defined by the individual, rather than comparing them to a general population norm or system benchmark.
03Goal Attainment Scaling is proposed as a method to quantify progress toward personally defined goals, though it requires careful handling of response bias in people with cognitive limitations.
STILL TO COME
How it was doneWhat they found
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What it does not show
This is a narrative review and theoretical discussion, not a clinical trial or systematic review with meta-analysis, so it does not provide evidence of treatment efficacy. The paper focuses on the US Medicaid HCBS system, so the regulatory and funding context may not apply to therapists in other countries or private practice. The proposed measures (RTC/OM) are still in development and field-testing, so they are not yet widely available or validated for routine clinical use. The paper does not report patient outcomes or clinical results, but rather discusses the methodology of measuring outcomes.
Declared interests
The development of this manuscript was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), federal grant # 90RT5039. The authors are affiliated with the Rehabilitation Research and Training Center on HCBS Outcome Measurement, which was funded by this grant.
The easy way to misread this
Do not interpret this as evidence that a specific intervention improves outcomes. This paper critiques how outcomes are measured in social care systems, not the effectiveness of therapies. Also, do not assume Goal Attainment Scaling is a validated, off-the-shelf tool for your clinic; it requires specific training and adaptation to be used reliably with people who have cognitive limitations.