Patient experiences in rural Northern Ontario: small hospital utilization and perspectives on community paramedicine
Bibliographic record
Abstract
This thesis adhered to an integrated article format with two distinct studies focusing on \nthe analysis of patient medical records from a rural hospital in north east Ontario (Study \n1) and a cross-sectional observational investigation of patient perspectives on community \nparamedicine (CP) (Study 2). The aim of Study 1 was to help hospital administrators \nidentify patients at high risk of frequent hospital resource utilization (emergency \ndepartment (ED) visit or admissions) so that if appropriate, they may be redirected to \nalternative services available in the community. Therefore, the two main research \nquestions for this study were: (1) Which types of patients are more prone to having repeat \nED visits and hospital admissions; and (2) What types of services could better serve or \nhelp improve the health of these patients? Study 2 aimed to evaluate patient and caregiver \nperspectives related to their involvement in three CP programs in rural communities \nacross Northern Ontario. There were two research questions guiding the evaluation of \npatient perspectives in this study: (1) How effective is CP at supporting patient-centered \ncare; and (2) How do perceptions differ between home visit (HV) and wellness clinic \n(WC) patients? In Study 1, twenty-six patients met the criteria for repeat ED visits (65% \nfemale; mean age 52 years) and accounted for a total of 623 ED visits. Seventeen patients \nmet the criteria for repeat admissions (41.2% female; mean age 73 years) and accounted \nfor 69 repeat hospital admissions. The most common reason cited for repeat ED visits \nwas dressing changes and the most common reason cited for repeat admissions was \nchronic obstructive pulmonary disease. For Study 2, 91.7% (n=55) of patients reported being satisfied with the CP services they received and 98.3% (n=59) of the patients \nindicated that they would recommend CP to others. Patient perspectives of CP suggest \nthat the service model is consistent with a patient-centered framework that includes \ninterpersonal, psychosocial, clinical, and structural dimensions. The patients also valued \nCP for the ease of access and the reassurance provided by the paramedics monitoring \ntheir health concerns. Our studies found that an older population with increased health \nneeds appear acceptable towards receiving alternative health care services outside of the \nhospital. Based on the perspectives of patients currently enrolled in CP programs across \nNorthern Ontario, the HV and WC services of CP appeared to be considered as an \nacceptable program that can provide patient-centered care in rural and northern \ncommunities. Collectively, these two studies provide important data related to the patient \nexperience in a rural and northern health care system context. These are encouraging \nsigns that alternative health care services, like the CP programs, can address non-urgent \nissues for residents of northern and rural communities in Ontario.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.008 | 0.003 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".