Operationalizing a holistic health definition as a framework to guide comprehensive assessment at the point of care: a modified eDelphi study
Notice bibliographique
Résumé
Background: Holistic assessment of client needs is an important component of person-centred care planning. However, the comprehensive nature of some standardized assessment tools from a documentation perspective, such as the internationally validated interRAI Home Care (interRAI HC) assessment tool, can make conducting and experiencing the assessment as a person-centred and conversational process challenging for both the assessor and the client1. Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broader definition of health to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions2. To explore the use of PPH as a framework to guide person-centred care assessment and goal-setting conversations in home care, we sought to map PPH domains to assessment elements from the interRAI HC1. Methods: The study utilized a modified eDelphi approach to conduct a domain mapping exercise with a purposively sampled expert panel (n=25). The panel consisted of researchers, health care providers and older adults and caregivers. The eDelphi process was conducted in two stages, with each stage consisting of three survey rounds. In the first stage, the expert panel were asked to map 201 elements from the interRAI HC to the six PPH domains: 1) Bodily Functions; 2) Daily Functioning; 3) Mental Wellbeing; 4) Quality of Life; 5) Participation; and 6) Meaningfulness. The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the PPH domains. Results: In Stage 1, 189 of 201 elements reached consensus. These included: 80 assessment elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in the meaningfulness and participation pillars and 12 additional descriptors across the six PPH domains. Of these, two elements, each in both the meaningfulness and participation domains, and 10 of the 12 descriptors reached consensus. Learnings: The expert panel reached agreement on mapping 94% of the assessment elements drawn from the interRAI HC to the six domains of the PPH, confirming the potential use of this framework to operationalize comprehensive and person-centred assessment conversations around a broader definition of health, building on existing international best practices in standardized assessment of home care client needs. Findings indicated interRAI HC assessment elements are oriented toward the physical, functional, and mental health PPH domains. Complementary assessment elements and/or tools may be needed to support comprehensive assessment of ‘meaningfulness’ and ‘participation’ domains in home and community care. Additional descriptors may be needed to aid communication about PPH domains. Next Steps: Home care clinicians will be engaged in leveraging study findings to co-design tools and resources to guide person-centred comprehensive assessment conversations, leveraging PPH domains and additional descriptors to structure dialogue around interRAI-HC elements and other potential complementary assessment elements and/or tools.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,125 | 0,070 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,003 |
| Études des sciences et des technologies | 0,005 | 0,007 |
| Communication savante | 0,005 | 0,005 |
| Science ouverte | 0,004 | 0,014 |
| Intégrité de la recherche | 0,002 | 0,004 |
| 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 ».