596 - Goal Cards: A Tool to Facilitate Patient-Centered Goals for Children with Medical Complexity

Poster Board #: 596
Publication #: EP-109.596

Background: Identifying patient-centered goals is an important component of shared plans of care (SPoCs), which are commonly used by children with medical complexity (CMC). The “SMART” (specific, measurable, actionable, related, and time-oriented) goal framework has been suggested as a paradigm for setting goals. However, few resources exist for clinicians and patients to identify patient-centered goals. We adapted one tool used in Dutch diabetes clinics, “treatment cards”, for use in setting goals with CMC.


Objective: Evaluate a pilot test of goal cards to create patient-centered goals for CMC using SMART framework.


Design/Methods:
This mixed methods study evaluated implementation of 39 goal cards encompassing five domains (communication; community, social/school; home/family; independence; and medical/health) during routine complex care clinic goal-setting discussions. Each goal card contains images and a phrase associated with a holistic view of health for CMC (Figure 1). Cards were available in physical (laminated 4x6 card) and electronic (website) formats to facilitate use during in-person or telemedicine visits. We piloted goal cards to set SMART goals with ten patients. Goals documented in the SPoCs of the pilot patients were audited before and after goal card intervention using a scale of 0-5, with a point awarded for each element of the SMART framework that the goal contained. Two facilitated, semi-structured focus groups about goal cards were held, one comprised of parents of CMC and one comprised of complex care interprofessional team members, and transcripts were analyzed using conventional content analysis.


Results: 66 documented goals were audited, 29 pre-intervention and 37 post-intervention. Mean scores (SD) for goals were 3.66 (1.23) and 4.24 (0.68) pre- and post-intervention respectively, demonstrating an average increase in score of 0.58 (95% CI 0.1-1.05, p=0.02). Themes and representative quotations from the parent and complex care interprofessional team focus groups can be found in Table 1. All parents and team members who participated in the focus groups indicated goal cards would improve or support the discussion of goals. All parents felt that goal card use should continue.

Conclusion(s): Use of goal cards helped identify patient-centered goals in pilot testing, and both parents and complex care team members had positive impressions of the goal cards. Future work includes expanding goal card use to community settings, evaluating workflows and testing effectiveness of goal cards to improve goal attainment.

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Authors/Institutions: Mary Ehlenbach, Univ of WI School of Medicine & Public Health, Madison, Wisconsin, United States; Rebecca Burns, Wisconsin Department of Health Services, Madison, Wisconsin, United States; Gemma Warner, UW-Madison, School of Medicine, Madison, Wisconsin, United States; Lindsey McGowan, University of Wisconsin, Madison, Wisconsin, United States; K. Jane Lee, Medical College of Wisconsin, Milwaukee, Wisconsin, United States; Tera C. Bartelt, Children's Hospital of Wisconsin, West Bend, Wisconsin, United States; Sarah Johaningsmeir, Medical College of Wisconsin, Milwaukee, Wisconsin, United States; Colleen Lane, Children's Health Alliance, Madison, Wisconsin, United States; Abby Hammes, Wisconsin Department of Health Services, Madison, Wisconsin, United States; Bridget Rolek, Parent Partner, Evansville, Wisconsin, United States; Barbara J. Katz, Family Voices of Wisconsin, Madison, Wisconsin, United States; Heidi M. Kloster, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States; Ryan J. Coller, University of Wisconsin, Madison, Wisconsin, United States