Developing a Multi-Dimensional Patient Assessment System for Community Paramedicine Home Visit Programs in Ontario, Canada

Abstract

This thesis presents a systematic framework for developing and evaluating a multi-dimensional patient assessment system for community paramedicine home visit programs. Underlying all of this work was a hypothesis that multi-dimensional patient assessment systems hold clinical utility to inform care planning activities, which in turn can direct appropriate patient care. I outline considerations for using assessment instruments to assist in the assessment process including strengths and weaknesses of using single-dimension or multi-dimensional assessment instruments when attempting to complete a consistently organized, multi-domain, and comprehensive assessment. The thesis includes a framework that outlines the major stages in developing and evaluating a new multi-dimensional patient assessment system. The framework uses community paramedicine home visit programs as an example of its application and subsequent chapters present and discuss key research questions related to each stage of the development and evaluation process; establishing a comprehensive set of clinical observations to be assessed and the related application of assessment findings to care planning activities. Two chapters explore existing assessment practices in community paramedicine home visit programs with findings that informed creation of a prototype assessment system that was pilot-tested. The fifth chapter describes results of the pilot-test and the sixth chapter investigates the clinical utility of the prototype assessment system to care planning of community paramedics. The development approach is informed by next-generation assessment practices and my work evaluating community paramedicine home visit programs provides a basis for appraisal of evidence in an emerging practice setting that does not have broadly established clinical practice guidelines. The accumulation of the evidence established in my thesis has led to the creation of a multi-dimensional patient assessment system for community paramedicine home visit programs. My research methods and findings can assist clinicians, decision makers or other researchers where a multi-dimensional assessment system is being developed or implemented.