JMIR Publications

ABSTRACT

Background:

Shared goal-setting is a common feature of quality guidelines to improve care quality for children with medical complexity (CMC), but few studies have examined the efficacy of interventions designed to improve goal-setting.

Objective:

To evaluate a novel Internet-based tool to promote shared goal-setting (GoalKeeper) in the care of children with medical complexity (CMC).

Methods:

Randomized controlled trial (intervention versus usual care) between 4/1/19-3/21/21 at primary and subspecialty care clinics at an academic medical center, including 11 medical providers (MD, DO, or NP). Parent eligibility: 18 years, English-speaking, with home Internet access, and with a CMC < age 12. Intervention: GoalKeeper was co-designed by parents, providers, and computer scientists to include two modules: 1) Goal elicitation, used during a clinic visit. 2) Tracking, used between visits. Primary outcome: Quality of goal-setting assessed by the Patient Assessment of Care for Chronic Illness Care (PACIC) goal-setting domain at baseline (t1) and 1 month (t2). Analysis: Repeated measures mixed-effects ANOVA to evaluate between- and within-group differences over time for fixed effects (timing of intervention, intervention*time) and random effect (provider cluster).

Results:

We enrolled 67 parent-child dyads (32 control, 35 intervention). Mean parent age 37.4 years (SD 8.2), mean child age 5.6 years (SD 0.5), and 29 parents (44%) identified as Hispanic. Quality of goal setting was sustained at t2 for the intervention group but declined for the control group (delta -0.43 versus 0.03; F-statistic 3.52, p=0.06). Similar patterns observed for care quality (delta -0.48 versus 0.01; F-statistic 4.28, p=0.04).

Conclusions:

Technologies that support goal-setting during clinical encounters may augment health-system efforts to advance high-quality chronic illness care. Clinical Trial: clinicaltrials.gov (NCT03620071)