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9.6 Resource Goal - Content

Patient Care icon Work GroupMaturity Level: 2 Trial UseSecurity Category: Patient Compartments: Group, Patient

Describes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc.

9.6.1 Scope and Usage

A Goal in health care services delivery is generally an expressed desired health state to be achieved by a subject of care (or family/group) over a period or at a specific point of time. This desired target health state may be achieved as a result of health care intervention(s) or resulting from natural recovery over time. For example:

  • A goal of a plan for a condition such as a diabetes might specify desired outcome(s) (e.g. HgbA1c level =<5.6% in 3 months) as a result of interventions such as medication therapy, nutritional management and/or increased physical activity.
  • A goal of a procedure might be to meet the intended objective of the procedure (e.g. wet-dry-dressing changes twice a day; goal: wound healed completely in 2 weeks) or to prevent an unintended complication (e.g. repositioning a patient every two hours: goal to maintain skin integrity)

Goals may address the prevention of illness, cure or mitigation of a condition, prolongation of life, or mitigation of pain and discomfort.

When dealing with groups, goals may also reflect health state, such as a reduction of addiction behaviors. However, they may also reflect population health objectives such as education, screening, etc.

Organizational goals are typically not health state specific but may instead identify measurement targets such as infection control, cost management, patient satisfaction, etc.

9.6.2 Boundaries and Relationships

Goals are typically established in the context of a CarePlan. However, goals may also be directly referenced by request-type resources (e.g. MedicationRequest or ServiceRequest) by using an extension.

A goal represents a specific goal instance for a particular patient, group, etc. It is not intended to be used to define types of potential goals as part of an order set or protocol definition. Protocol definitions and order sets are supported through PlanDefinition. The Goal resource is intended to be used once an order set is instantiated or assigned to a patient, which is when the potential goals become the actual goals, if not changed or deleted.

Goals are often evaluated using Observations.

Goal does not include the legal Advance Directives, which should be represented with the Consent resource with Consent.category = Advance Directive or a request resource with the intent = directive. Legal Advance Directives may specify clinical goals that can be represented as a Goal resource as well. Informally, advance directives could be represented as a Goal resource regardless of whether it was included in the legal Consent, such as "I want to die at home."

9.6.3 References to this Resource

9.6.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. Goal TU DomainResource Describes the intended objective(s) for a patient, group or organization

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier 0..* Identifier External Ids for this goal

... lifecycleStatus ?!Σ 1..1 code proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected
Binding: Goal Lifecycle Status (Required)
... achievementStatus Σ 0..1 CodeableConcept in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable
Binding: Goal Achievement Status (Preferred)
... continuous 0..1 boolean After meeting the goal, ongoing activity is needed to sustain the goal objective
... priority Σ 0..1 CodeableConcept high-priority | medium-priority | low-priority
Binding: Goal Priority (Preferred)
... description Σ 1..1 CodeableConcept Code or text describing goal
Binding: Goal Description (Example)
... subject Σ 1..1 Reference(Patient | Group | Organization) Who this goal is intended for
... start[x] Σ 0..1 When goal pursuit begins
Binding: Goal Start Event (Example)
.... startDate date
.... startCodeableConcept CodeableConcept
... acceptance 0..* BackboneElement Individual acceptance of goal

.... participant 1..1 Reference(Patient | Practitioner | RelatedPerson | PractitionerRole | CareTeam | Organization) Individual or organization whose acceptance is reflected
.... status 0..1 code agree | disagree | pending
Binding: Goal acceptance status value set (Required)
.... priority 0..1 CodeableConcept Priority of goal for individual
Binding: Goal Priority (Example)
... target C 0..* BackboneElement Target outcome for the goal
+ Rule: Goal.target.measure is required if Goal.target.detail is populated

.... measure ΣC 0..1 CodeableConcept The parameter whose value is being tracked
Binding: LOINC Codes (Example)
.... detail[x] ΣC 0..1 The target value to be achieved
..... detailQuantity Quantity
..... detailRange Range
..... detailCodeableConcept CodeableConcept
..... detailString string
..... detailBoolean boolean
..... detailInteger integer
..... detailRatio Ratio
.... due[x] Σ 0..1 Reach goal on or before
..... dueDate date
..... dueDuration Duration
... statusDate Σ 0..1 date When goal achievment status took effect
... statusReason 0..* CodeableConcept Reason for current lifecycle status
Binding: Goal Status Reason (Example)

... source Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | CareTeam | Group) Who's responsible for creating Goal?
... addresses 0..* Reference(Condition | Observation | MedicationStatement | MedicationRequest | NutritionOrder | ServiceRequest | RiskAssessment | Procedure | NutritionIntake) Issues addressed by this goal

... note 0..* Annotation Comments about the goal


doco Documentation for this format icon

See the Extensions for this resource

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

9.6.4.1 Terminology Bindings

Path ValueSet Type Documentation
Goal.lifecycleStatus GoalLifecycleStatus Required

Codes that reflect the current state of a goal and whether the goal is still being targeted.
Goal.achievementStatus GoalAchievementStatus Preferred

Describes the progression, or lack thereof, towards the goal against the target.
Goal.category GoalCategory Example

Example codes for grouping goals to use for filtering or presentation.
Goal.priority GoalPriority Preferred

Indicates the level of importance associated with reaching or sustaining a goal.
Goal.description GoalDescription Example

Example value set for Goal descriptions.
Goal.start[x] GoalStartEvent Example

Identifies types of events that might trigger the start of a goal.
Goal.acceptance.status GoalAcceptStatus (a valid code from Goal acceptance status code system) Required

Codes that identify whether the goal has been accepted or not.
Goal.acceptance.priority GoalPriority Example

Indicates the level of importance associated with reaching or sustaining a goal.
Goal.target.measure LOINCCodes (a valid code from LOINC icon) Example

This value set includes all LOINC codes
Goal.statusReason GoalStatusReason Example

Codes to identify the reason for current lifecycle status.

9.6.4.2 Constraints

UniqueKeyLevelLocationDescriptionExpression
img gol-1Rule Goal.targetGoal.target.measure is required if Goal.target.detail is populated(detail.exists() and measure.exists()) or detail.exists().not()

9.6.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
achievement-status token in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Goal.achievementStatus
addresses reference Issues addressed by this goal Goal.addresses
(Condition, RiskAssessment, MedicationRequest, NutritionOrder, Observation, Procedure, NutritionIntake, MedicationStatement, ServiceRequest)
category token E.g. Treatment, dietary, behavioral, etc. Goal.category
description token Code or text describing goal Goal.description
identifier token External Ids for this goal Goal.identifier 65 Resources
lifecycle-status token proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Goal.lifecycleStatus
patient reference Who this goal is intended for Goal.subject.where(resolve() is Patient)
(Patient)		 65 Resources
start-date date When goal pursuit begins (Goal.start.ofType(date))
subject reference Who this goal is intended for Goal.subject
(Group, Organization, Patient)
target-date date Reach goal on or before (Goal.target.due.ofType(date))
target-measure token The parameter whose value is being tracked Goal.target.measure