Person-centered outcome measures

A learning collaborative from NCQA on implementing standardized measurement of patient-driven goals

Care management & redesign Data analysis & integration Measurement & evaluation Quality improvement

Care team members care planning with a participant during a home visit

A core tenet of complex care is that care is centered around the needs and goals of the patient.

This has posed a challenge, though, to efforts to measure the success of complex care programs in a standardized way. When each participant has unique goals, it is difficult to capture and compare their progress systematically.

In 2022, the Camden Coalition was invited by the National Committee for Quality Assurance (NCQA) to join a learning collaborative to help test and refine NCQA’s Person-Centered Outcome (PCO) Measures. Each participating organization receives support in implementing the PCO measures and sends data to NCQA quarterly to be assessed for fidelity.

Goal attainment scaling

One of the two methods identified by NCQA for documenting, tracking, and measuring progress toward person-centered outcomes — and the one the Camden Coalition chose to focus on — is called goal attainment scaling.

Goal attainment scaling is a way to quantify our participants’ progress toward the goals they identify. Once the care team identifies what matters most to the participant, they work with the participant to create a scale describing each of the following possible outcomes:

  • (-2) Worse – worst case scenario
  • (-1) Current state – the participant’s current challenge
  • (0) Realistic goal – where they want to be in X weeks/months
  • (+1) Stretch goal – somewhat better than where they want to be
  • (+2) Super stretch goal – best possible outcome

The scale guides care team members and participants as they work together to create a plan to achieve the goal and to address any potential barriers to progress or achievement. Using goal attainment scaling creates a standardized way to compare participants’ progress despite working toward different goals.

Learn more about our work implementing PCO measures and goal attainment scaling as part of NCQA’s learning collaborative in our demonstration snapshot.