The implementation of patient-reported outcome (PRO) models to evaluate treatment response has intensified across all domains of healthcare with the advent of new payment models that pay physicians and hospitals on the basis of clinical outcomes and patient satisfaction. The field of brain injury rehabilitation is no exception, with researchers and clinicians in the field of cognitive rehabilitation working to embrace patient PRO assessment models. Cognitive rehabilitation, however, poses some unique challenges to the implementation of PRO. Scales must map the cognitive domain being evaluated to a functional change and capture the importance of that change to the individual. Further complicating the goal to develop ecologically valid and sensitive PROs are the reporting barriers produced by common cognitive deficits in self-awareness and memory that can undermine the validity of self-reporting. The proposed project builds on our existing work to develop patient-centered outcome measures that objectively capture potential changes produced by cognitive rehabilitation by integrating goal attainment scaling (GAS) and motivational interviewing. Supported by a previous research grant, we developed an app, electronic goal attainment scaling (eGAS), that produces levels of progress that are measurable, attainable, and equidistant for client-selected goals that are directly related to the cognitive intervention. A pilot trial with 26 practicing medical speech language pathologists across the United States indicated that the eGAs app successfully facilitated collaborative goal setting and the construction of valid goal hierarchies. However, the feasibility of using eGAS within the time constraints and mandated assessment and paperwork policies in medical practice settings was low. The pilot users also identified additional app components that would increase usability and usefulness in practice settings. The central aim of this R03 proposal is to update the eGAS app such that it would be implemented in the private sector to produce valid, patient-generated goal attainment scales. Initially, the software engineer will design and program the priority features identified in the pilot that include additional content to make the app usable in inpatient and outpatient settings. This will be followed by feasibility trials conducted at two premier brain injury centers. The feasibility trials will be conducted in two 4-month blocks separated by an interim 4-month development block during which the app will be updated and any identified bugs will be fixed to turn the app around for a second round of feasibility testing. Evaluating methods to import eGAS reports into electronic medical records at our feasibility sites will occur during the feasibility trials. The project would enable the development of a clinically feasible eGAS tool that could be evaluated in larger trials. It would also contribute to the knowledge base about implementation factors relevant to participant-centered outcomes in brain injury rehabilitation.
The most recent CDC statistics document 181 hospitalizations following traumatic brain injury per 100,000 in the U.S. population, most of whom require services for cognitive impairments. The proposed project seeks to address the urgent need for valid, patient-centered outcomes sufficiently sensitive to measure cognitive treatment outcomes. The innovative eGAS tool facilitates the generation of valid, reliable goal hierarchies linked to specific cognitive interventions.
