Implementing Goal Attainment Scaling as a Person-Centered Measurement Tool to Direct Care and Evaluate Outcomes in Neurorehabilitation Settings.

Abstract

The purpose of this Special Communication is to describe barriers and facilitators to implementing goal attainment scaling (GAS) as a patient-centered measurement tool in neurorehabilitation settings. The experiences of 3 distinct neurorehabilitation settings that implemented GAS to enhance person-centered care and measure person-centered goal attainment are described: a neurorehabilitation service at an inpatient rehabilitation facility; an intensive outpatient program serving military service members, veterans, and first responders with a history of mild to moderate traumatic brain injury; and an outpatient clinic serving adolescents and adults with recent history of mild traumatic brain injury. Each setting instituted different methods to implement GAS yet experienced commonalities in barriers and facilitators to implementation and adoption. Experiences were thematically organized using the normalization process theory (NPT), a framework that supports the design and evaluation of clinical process implementation. Barriers clustered in the NPT domains of coherence and cognitive participation, including factors such as staff training requirements, time required to implement, and challenges related to shifting program philosophies. Implementation was facilitated by actions taken in collective action and reflexive monitoring domains, such as integrating processes into workflows, leveraging technology for team communication and measurement, and completing regular audits and staff feedback. Patient-centered measurement tools, such as GAS, provide a framework for capturing patient priorities, enhancing the relevance of care plans, and ensuring treatment goals align with individual patient needs. Evaluating GAS implementation using the NPT provides direction to future clinical implementation efforts, which should continue to integrate clinical experiences with those of the persons served.