Two components of a measurable goal are the target value and the expected time frame for meeting the target value. We learned in previous chapters that the target value can be written in terms of a change score or as an absolute value for the outcome of interest. Having found prognostic evidence regarding your patient's condition, the trick now is to place a time estimate on when you think the patient might expect to experience an appreciable change in his or her condition. Our take is that there is less evidence to guide decisions regarding temporal elements of goals than even the goals themselves. We have come up with two approaches that may help you in deciding on the optimal time frames for reevaluating your patients to assess for progression toward goal attainment.
In this chapter we describe two methods for identifying the anticipated time frame for meeting a goal. We also introduce the important concept that ignoring the ideal reassessment interval will increase the error rate in determining whether patients have met their goal values.
The Concept Behind This Question
Determining optimal reassessment intervals requires knowledge of the expected change profile for patients similar to the patient of interest and a measurement strategy that maximizes the accuracy of clinical decisions formed at the time of reassessment. There are two important concepts embedded in this statement.
The first idea is that change profiles exist for specific conditions and patient characteristics and that this evidence can be found in the literature. The second thought is that optimal reassessment intervals exist and that these intervals will vary depending on where a patient is with respect to the clinical course of the condition. By change profile, we mean how a patient's value on the outcome of interest changes over time. Included in this concept are both the expected rate of change and the absolute values of the outcome measure at all points in time over the clinical course of a condition. The second concept acknowledges that specifying the appropriate reassessment interval will enhance the accuracy of determining whether a goal has been met or not. We show that reassessments can be most efficient if they are done at a time when expected changes are optimally estimated. Your time is valuable and reassessments take time. Completing reassessments at optimal points in time during the plan of care makes most efficient use of the time you have to reassess your patients.
Methods Used to Determine Target Goal Values
Modeling Change Over Time: Growth Curves: What Is It?
This approach seeks to identify a change profile for patients who have conditions and characteristics that are similar to those of your patient. The profile is usually expressed as an equation (growth model) and as a pictorial representation that graphs ...