Goal-Oriented Health Care

Health care that supports the efforts of  each individual to clarify, pursue, and achieve their health-related goals. The most common health-related goal areas are:

1) Prevention of premature death and disability

2) Maintenance and enhancement of current quality of life

3) Optimization of personal growth and development

4) A good death. 

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A foundational assumption of goal-directed health care is that the strategies derived from patient goals are likely to be more effective and efficient than those derived from problem-solving if the outcomes of interest are those that are meaningful to patients. 

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Key Definitions:

• Goal: A desired outcome that can stand on its own merits. That is, it makes little sense to ask, “so that ...?”

• Objective: A measurable step along the path toward a goal.

• Strategy: A way to reach the objectives and ultimately achieve a goal. [For example, my 90-year-old mother does balance and leg-strengthening exercises (strategy), in order to be able to walk safely without her walker (objective), so that she can go outside and take care of her plants (her goal).]

• Obstacle: Anything that gets in the way of the achievement of a goal.

• Challenge: An optimistic way to think about an obstacle.

• Opportunity: An even more optimistic way to view an obstacle.

• Threshold Principle: The idea that nearly all health challenges are the result of combinations of factors, and that, in each case, a threshold exists above which that combination of factors becomes a significant obstacle to achieving a health goal.

• Prioritization: A ranking of strategies based upon their expected impact and feasibility.

• Premature death: Death resulting from a potentially preventable cause.

• Premature disability: Disability resulting from a potentially preventable cause.

• Life expectancy: The number of additional years a person is expected to live.

• Health expectancy: The number of additional years a person is expected to live free of disability.

• Quality of Life: An assessment of how great it is to be alive based upon ones ability to participate in meaningful activities and relationships

• Meaningful Life Activity: An activity that gives life joy, purpose, or meaning.

• Optimal Growth and Development: 1) Achievement of major developmental tasks; 2) development of resilience, adaptability, and the ability handle challenges; and 3) acquisition of the skills required to help others.

• A Good Death: A death that is 1) free from avoidable distress and suffering, for patients, family, and caregivers; 2) in general accord with the patients’ and families’ wishes; and 3) reasonably consistent with clinical, cultural, and ethical standards.