Assessing capacity in the complex patient: RCAT's unique evaluation and consultation model.
Notice bibliographique
Résumé
Abstract This paper describes the development of a unique multidisciplinary patient assessment team, the Regional Capacity Assessment Team (RCAT), which operates in the Calgary Health Region of Alberta. The goals of this paper are to provide a brief review of seminal models that influenced RCAT's development, discuss its ethical and theoretical underpinnings, and provide an overview of the RCAT approach to the completion of complex assessments. The overview of the RCAT model will elucidate our multidisciplinary assessment algorithm, our consultation model, and describe our specialized assessment tools. This paper will be of interest to health care practitioners and administrators looking for a cost-effective, efficient, and clinically sound model for complex assessments. Capacity issues are challenging for everyone involved, due to the multiple legal, ethical, and medical factors involved. The Regional Capacity Assessment Team (RCAT) is currendy the only multidisciplinary team in Canada with the sole function of assessing and addressing issues. It was created in 2005 to address the multiple complexities of evaluations. RCAT serves the Calgary Health Region (CHR), which has a geographic area of 39,260 square kilometres and which serves a population of 1,143,368 (CHR, 2004). The CHR's main source of revenue (87%) is Alberta Health and Wellness (CHR, 2004). RCAT's assessment and consultation mandate includes the provision of services to all adults who have reached the age of majority, with no exclusionary criteria related to diagnosis. RCAT's patients have included adults with dementia, brain injury, psychiatric illness, addiction, and developmental disability. Frequently, there are co-morbid diagnoses, multiple medical conditions, and significant psychosocial stressors present. RCAT assessments are conducted across the CHR care spectrum, which includes acute care, community, and continuing care sites. Capacity is a socio-legal construct frequently used in the health care domain in relation to decisions about a patient's medical and social care (Weisstub, 1990). Although definitions of vary by jurisdiction, RCAT conceptualizes as the ability to use cognitive processes to understand and identify options, to appreciate the consequences of different options, and to follow through (or direct a surrogate to follow dirough) with chosen options. This conceptualization of capacity, especially as it incorporates understanding and appreciation, reflects current practice and literature in the field (Grisso & Appelbaum, 1998; Office of the Public Guardian and Trustee & Ontario Ministry of the Attorney General, 2000; Weisstub, 1990; Yukon Department of Justice, 2004). Current clinical practice also differentiates between capacity and competency. The term capacity is used in relation to the clinical assessment and determination of a patient's decision-making abilities by health care professionals. By contrast, the term competency refers to the court's decision and ruling regarding the clinical determination of (Brody, 2005; Checkland & Silberfeld, 1995; Lapid et al., 2003; Sturman, 2005; Sullivan, 2004; Wyszynski & Garfein, 2005). Seminal Capacity Models in the Literature At the inception of RCAT, and approximately four months prior to opening our clinic doors, an extensive review of existing models representative of North America, Europe, Asia, and Australia was completed. For brevity, this paper will highlight five key Canadian models and approaches that particularly influenced the conceptualization and development of our team. Baycrest Competency Clinic (Ontario) The Competency Clinic for the elderly (now closed) at the Baycrest Centre in Toronto incorporated a multidisciplinary team, with a primary goal of developing and refining criteria of (Silberfeld et al., 1988). …
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,026 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,006 |
| Communication savante | 0,006 | 0,003 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».