Using goal attainment scaling to improve the quality of long-term care: a group-randomized trial

Objective. To assess the effect of a 6-month interdisciplinary customized intervention based on goal attainment scaling and aimed at improving the quality of care provided by long-term care facilities to frail older adults. Design. A pair-matched group-randomized trial with quality of care measurements taken before and after the intervention and 6 months later. Settings. Forty unregulated small-to-medium sized long-term care facilities delivering inadequate care to at least one resident. Facilities were matched on baseline quality of care, health district, and size. One member of each pair was then randomly allocated to the intervention, the other acting as a control. Study participants. The trial involved 201 frail older adults randomly selected from the 40 participating facilities. Intervention. The intervention was tailored to the main quality problems identified at baseline in the facility. The first task of the intervention team was to set weighted quality improvement goals with the facility manager, which were then recorded on a goal attainment follow-up guide. Subsequent monthly on-site visits, interspersed with frequent telephone calls, were meant to assist the manager and staff to implement permanent changes in the areas of care targeted for improvement. Main outcome measure. Quality of care measured with the Quality of Care (QUALCARE) Scale, a multidimensional instrument that uses a 5-point scale to assess six subdimensions of care: environmental, physical, medical management, psychosocial, human rights, and financial. A score greater than 2 is considered indicative of inadequate care. Results. The intervention effect on the overall quality of care was neither clinically nor statistically significant. Change from baseline to the end of the intervention averaged .21 and .22 in the experimental and control conditions, respectively (P=0.86). Conclusion. Attainment of preset quality improvement objectives did not translate into detectable improvements in the care provided to residents.