Stolee P, Rockwood K, Fox R A, Streiner D L
Department of Health Studies, University of Waterloo, Canada.
J Am Geriatr Soc. 1992 Jun;40(6):574-8. doi: 10.1111/j.1532-5415.1992.tb02105.x.
Goal attainment scaling (GAS) is a measurement approach used extensively in mental health. It accommodates multiple individual patient goals, yet retains mathematical properties allowing comparisons between patients. This study was carried out to investigate the feasibility and measurement properties of GAS in a geriatric care setting.
Prospective descriptive study.
The geriatric restorative care service and geriatric assessment unit at Camp Hill Hospital, a 350-bed tertiary care facility in Halifax, Canada.
Fifteen patients aged 65 to 94 who were consecutively admitted to the two geriatric services (mean age 79 years, mean length of stay 37 days, 9 females).
Goal Attainment follow-up guides were developed independently for each patient by two geriatricians after a comprehensive assessment of the patient. These guides were later compared to assess level of agreement in goal setting and scale development. A single goal attainment follow-up guide was then developed for each patient by consensus of the two geriatricians. At the end of the follow-up, the guides were scored independently for each patient by one of the geriatricians and by the patient's primary care nurse.
GAS scores were determined on admission and discharge. Each patient also received admission and discharge ratings on the Barthel Index as well as a global rating of outcome (on a subjective 10-point scale) by a geriatrician who was blinded to the Goal Attainment follow-up score.
GAS proved feasible, requiring 15-20 minutes to scale an average of six goals per patient. GAS also appears reliable. Of 87 goals, 71 (82%) were identified independently by two geriatricians, and the remainder were determined by consensus. This is also a measure of content validity. The physician-nurse inter-rater reliability was 0.87 (intraclass correlation). Concurrent validity was assessed by correlation with the Barthel Index (r = 0.86) and the global clinical outcome rating (r = 0.82). Content validity was also assessed by comparing our goal areas with those identified in recent consensus reports on geriatric assessment. Of these 13 assessment areas, 12 appeared to be reasonably well covered while one assessment area (sexual problems) was not identified for any of the 15 patients.
GAS appears to be a feasible method of goal setting and outcome evaluation in geriatric care settings, with promising reliability and validity.
目标达成量表（GAS）是一种在心理健康领域广泛应用的测量方法。它适用于多个个体患者目标，同时保留了允许患者间进行比较的数学特性。本研究旨在调查GAS在老年护理环境中的可行性和测量特性。
前瞻性描述性研究。
加拿大哈利法克斯一家拥有350张床位的三级护理机构坎普希尔医院的老年康复护理服务部门和老年评估单元。
15名年龄在65至94岁之间的患者，他们连续入住这两个老年服务部门（平均年龄79岁，平均住院时间37天，9名女性）。
两名老年科医生在对患者进行全面评估后，为每位患者独立制定目标达成随访指南。随后对这些指南进行比较，以评估目标设定和量表制定的一致性水平。然后，两名老年科医生通过协商一致为每位患者制定一份单一的目标达成随访指南。随访结束时，由一名老年科医生和患者的初级护理护士分别对指南进行评分。
在入院时和出院时确定GAS评分。每位患者还接受了巴氏指数的入院和出院评分，以及一位对目标达成随访评分不知情的老年科医生给出的总体结局评分（主观的10分制）。
GAS被证明是可行的，为每位患者平均六个目标进行评分需要15至20分钟。GAS似乎也具有可靠性。在87个目标中，71个（82%）由两名老年科医生独立确定，其余目标通过协商一致确定。这也是内容效度的一种衡量方法。医生与护士之间的评分者信度为0.87（组内相关系数）。通过与巴氏指数（r = 0.86）和总体临床结局评分（r = 0.82）的相关性评估了同时效度。通过将我们的目标领域与近期老年评估共识报告中确定的目标领域进行比较，也评估了内容效度。在这13个评估领域中，如果12个领域似乎得到了合理的涵盖，而15名患者中没有任何一人被确定存在一个评估领域（性问题）。
GAS似乎是老年护理环境中设定目标和评估结局的一种可行方法，具有可靠的信度和效度。
