Keeping PACE With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy
DOI:
https://doi.org/10.5195/ijt.2021.6379Keywords:
Occupational therapy, PACE Framework, Program evaluation, Research, TelehealthAbstract
The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy. The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework’s domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation.
References
American Occupational Therapy Association [AOTA]. (n.d.-a). AOTA unveils Vision 2025. https://www.aota.org/AboutAOTA/vision-2025.aspx
American Occupational Therapy Association [AOTA]. (n.d.-b). Diversity, equity, and inclusion in occupational therapy. https://www.aota.org/About-Occupational-Therapy/diversity.aspx
American Occupational Therapy Association [AOTA]. (n.d.-c). Safe at Home Checklist. https://www.aota.org/~/media/Corporate/Files/Practice/Aging/rebuilding-together/RT-Aging-in-Place-Safe-at-Home-Checklist.pdf
American Occupational Therapy Association [AOTA]. (2005). Telerehabilitation position paper. American Journal of Occupational Therapy, 59, 656-660. https://doi.org/10.5014/ajot.59.6.656
American Occupational Therapy Association [AOTA]. (2010). Telerehabilitation [Position Paper]. American Journal of Occupational Therapy, 64, S92-S102. https://doi.org/10.5014/ajot.2010.64S92
American Occupational Therapy Association [AOTA]. (2013). Telehealth [Position Paper]. American Journal of Occupational Therapy, 67, S69-S90. https://doi.org/10.5014/ajot.2013.67S69
American Occupational Therapy Association [AOTA]. (2018). Telehealth in occupational therapy [Position Paper]. American Journal of Occupational Therapy, 72(Suppl. 2), 7212410059. https://doi.org/10.5014/ajot.2018.72S219
American Occupational Therapy Association [AOTA]. (2020a). AOTA’s Guide to Acknowledging the Impact of Discrimination, Stigma, and Implicit Bias on Provision of Services. https://www.aota.org/-/media/Corporate/Files/Practice/Guide-Acknowledging-Impact-Discrimination-Stigma-Implicit-Bias.pdf
American Occupational Therapy Association [AOTA]. (2020b). Occupational therapy’s commitment to diversity, equity, and inclusion. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410030. https://doi.org/10.5014/ajot.2020.74S3002
American Occupational Therapy Association [AOTA]. (2020c). Occupational therapy in the promotion of health and well-being. American Journal of Occupational Therapy, 74, 7403420010. https://doi.org/10.5014/ajot.2020.743003
American Occupational Therapy Association [AOTA]. (2020d). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001
American Occupational Therapy Association [AOTA]. (2021, February 19). COVID-19 state updates: Summary of telehealth, insurance, and licensure developments; and comprehensive state-by-state chart. https://www.aota.org/Advocacy-Policy/State-Policy/StateNews/2020/COVID-19-Summary-Telehealth-Insurance-Licensure.aspx
Barnes, C. R., & Adamson-Macedo, E. N. (2007). Perceived Maternal Parenting Self-efficacy (PMP S-E) tool: Development and validation with mothers of hospitalized preterm neonates. Journal of Advanced Nursing, 60(5) 550-560. https://doi.org/10.1111/j.1365-2648.2007.04445.x
Baron, K., Kielhofner, G., Iyenger, A., Goldhammer, V., & Wolenski, J. (2002). The Occupational Self Assessment: OSA: Version 2.0: a User's Manual. University of Illinois, College of Applied Health Sciences.
Bedell, G. (2011). The Child and Adolescent Scale of Participation (CASP) administration and scoring guidelines. http://sites.tufts.edu/garybedell/files/2012/07/CASP-Administration-Scoring-Guidelines-8-19-11.pdf
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573-576. https://doi.org/10.1370/afm.1713
Boot, W. R., Charness, N., Czaja, S. J., Sharit, J., Rogers, W. A., Fisk, A. D., Mitzner, T., Lee, C. C., & Nair, S. (2015). Computer proficiency questionnaire: Assessing low and high computer proficient seniors. Gerontologist, 55(3), 404-411. https://doi.org/10.1093/geront/gnt117
Chuo, J., Macy, M. L., & Lorch, S. A. (2020). Strategies for evaluating telehealth. Pediatrics, 146(5), e20201781. https://doi.org/10.1542/peds.2020-1781
Cohen, S. R., Russell, L. B., Leis, A., Shahidi, J., Porterfield, P., Kuhl, D. R., Gadermann, A. M., & Sawatzky, R. (2019). More comprehensively measuring quality of life in life-threatening illness: The McGill Quality of Life Questionnaire - Expanded. BMC Palliat Care, 18(1), 92. https://doi.org/10.1186/s12904-019-0473-y
Coster, W. Deeney, T., Haltiwanger, J., & Haley, S. (1998). School Function Assessment Psychological Corporation/Therapy Skill Builders.
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The job demands-resources model of burnout. Journal of Applied Psychology, 86(3), 499-512. https://doi.org/10.1037/0021-9010.86.3.499
Dumas, H. M., Fragala-Pinkham, M. A., Rosen, E. L., Lombard, K. A., & Farrell, C. (2015). Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) and Alberta Infant Motor Scale (AIMS): Validity and responsiveness. Physical Therapy, 95(11), 1559-1568. https://doi.org/10.2522/ptj.20140339
Dunn,W. (2014). Sensory Profile-2. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Motor-Sensory/Sensory-Profile-2/p/100000822.html
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Ford Foundation. (n.d.). Disability Inclusion Toolkit. https://www.fordfoundation.org/work/learning/research-reports/disability-inclusion-toolkit/
Forsyth, K., Deshpande, S., Kielhofner, G., Henriksson, C., Haglund, L., Olson, L., Skinner, S., & Kulkarni, S. (2005). The Occupational Circumstances Assessment Interview and Rating Scale Version 4.0. https://www.moho.uic.edu/productDetails.aspx?aid=35
Frost, J. S., Hammer, D. P., Nunez, L. M., Adams, J. L., Chesluk, B., Grus, C., Harvison, N., McGuinn, K., Mortensen, L., Nishimoto, J. H., Palatta, A., Richmond, M., Ross, E. J., Tegzes, J., Ruffin, A. L., & Bentley, J. P. (2019). The intersection of professionalism and interprofessional care: Development and initial testing of the interprofessional professionalism assessment (IPA). Journal of Interprofessional Care, 33(1), 102-115. https://doi.org/10.1080/13561820.2018.1515733
Heinemann, A. W. (2010). Measurement of participation in rehabilitation research. Archives of Physical Medicine and Rehabilitation, 91(9), S1-S4. https://doi.org/10.1016/j.apmr.2009.08.155
Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4p1), 1005-1026. https://doi.org/https://doi.org/10.1111/j.1475-6773.2004.00269.x
Huebner, E. S. (1991). Initial development of the student's life satisfaction scale. School Psychology International, 12(3), 231-240. https://doi.org/10.1177/0143034391123010
Hyland, M. E., & Sodergren, S. C. (1996). Development of a new type of global quality of life scale, and comparison of performance and preference for 12 global scales. Quality of Life Research, 5(5), 469-480. https://doi.org/10.1007/bf00540019
Karnoe, A., Furstrand, D., Christensen, K. B., Norgaard, O., & Kayser, L. (2018). Assessing competencies needed to engage with digital health services: Development of the eHealth Literacy Assessment Toolkit. Journal of Medical Internet Research, 20(5), e178. https://doi.org/10.2196/jmir.8347
Kayser, L., Karnoe, A., Furstrand, D., Batterham, R., Christensen, K. B., Elsworth, G., & Osborne, R. H. (2018). A multidimensional tool based on the eHealth literacy framework: Development and initial validity testing of the eHealth Literacy Questionnaire (eHLQ). Journal of Medical Internet Research, 20(2), e36. https://doi.org/10.2196/jmir.8371
Kielhofner, G., Mallinson, T., Forsyth, K., & Lai, J.-S. (2001). Psychometric properties of the second version of the Occupational Performance History Interview (OPHI-II). American Journal of Occupational Therapy, 55(3), 260-267. https://doi.org/10.5014/ajot.55.3.260
Kiresuk, T. J., & Sherman, R. E. (1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4(6), 443-453. https://doi.org/10.1007/BF01530764
Law, M., Baptiste, S., McColl, M., Opzoomer, A., Polatajko, H., & Pollock, N. (1990). The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57(2), 82-87. https://doi.org/10.1177/000841749005700207
Law, M., King, G., Petrenchik, T., Kertoy, M., & Anaby, D. (2012). The assessment of preschool children's participation: Internal consistency and construct validity. Physical & Occupational Therapy in Pediatrics, 32(3), 272-287. https://doi.org/10.3109/01942638.2012.662584
Little, L. M., Wallisch, A., Pope, E., & Dunn, W. (2018). Acceptability and cost comparison of a telehealth intervention for families of children with autism. Infants & Young Children, 31(4), 275-286. https://doi.org/10.1097/iyc.0000000000000126
Maslach, C., & Jackson, S. E. (1981). The measurement of experienced burnout. Journal of Organizational Behavior, 2(2), 99-113. https://doi.org/10.1002/job.4030020205
Matuska, K. (2012). Description and development of the Life Balance Inventory. Occupational Therapy Journal of Research, 32(1), 220-228. https://doi.org/10.3928/15394492-20110610-01
Maujean, A., Davis, P., Kendall, E., Casey, L., & Loxton, N. (2014). The Daily Living Self-Efficacy Scale: A new measure for assessing self-efficacy in stroke survivors. Disability and Rehabilitation, 36(6), 504-511. https://doi.org/10.3109/09638288.2013.804592
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
National Quality Forum. (2017). Creating a framework to support measure development for telehealth. https://www.qualityforum.org/Publications/2017/08/Creating_a_Framework_to_Support_Measure_Development_for_Telehealth.aspx
Nissen, R. M., & Serwe, K. M. (2018). Occupational therapy telehealth applications for the dementia-caregiver dyad: A scoping review. Physical & Occupational Therapy in Geriatrics, 36(4), 366-379. https://doi.org/10.1080/02703181.2018.1536095
Nobakht, Z., Rassafiani, M., Hosseini, S. A., & Ahmadi, M. (2017). Telehealth in occupational therapy: A scoping review. International Journal of Therapy and Rehabilitation, 24(12), 534-538. https://doi.org/10.12968/IJTR.2017.24.12.534
Nonprofit Association of Oregon. (2018). Equity and Inclusion Lens Guide. https://nonprofitoregon.org/sites/default/files/NAO-Equity-Lens-Guide-2019.pdf
Norman, C. D., & Skinner, H. A. (2006). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27
Northwestern University. (2021a). PROMIS® (Patient-Reported Outcomes Measurement Information System). https://www.healthmeasures.net/explore-measurement-systems/promis
Northwestern University. (2021b). NIH Toolbox®. https://www.healthmeasures.net/explore-measurement-systems/nih-toolbox
Ohan, J. L., Leung, D. W., & Johnston, C. (2000). The Parenting Sense of Competence Scale: Evidence of a stable factor structure and validity. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement, 32(4), 251-261. https://doi.org/10.1037/h0087122
Orchard, C. A., King, G. A., Khalili, H., & Bezzina, M. B. (2012). Assessment of Interprofessional Team Collaboration Scale (AITCS): Development and testing of the instrument. Journal of Continuing Education in the Health Professions, 32(1), 58-67. https://doi.org/10.1002/chp.21123
Parham, L. D., Ecker, C., Miller-Kuhaneck, H., Henry, D. A., & Glennon, T. J. (2007). SPM Sensory Processing Measure. Western Psychological Services.
Proffitt, R., Cason, J., Little, L., & Pickett, K. A. (2021). Stimulating research to advance evidence-based applications of telehealth in occupational therapy. Occupational Therapy Journal of Research, https://doi.org/10.1177/15394492211011433.
Radomski, M. V. (1995). There is more to life than putting on your pants. American Journal of Occupational Therapy, 49, 487–490. https://doi.org/10.5014/ajot.49.6.487
Regenstein, M. (2007). Measuring and improving the quality of hospital language services: Insights from the Speaking Together collaborative. Journal of General Internal Medicine, 22(2), 356-359. https://doi.org/10.1007/s11606-007-0358-2
Roque, N. A., & Boot, W. R. (2018). A new tool for assessing mobile device proficiency in older adults: The Mobile Device Proficiency Questionnaire. Journal of Applied Gerontology, 37(2), 131-156. https://doi.org/10.1177/0733464816642582
Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy Scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON.
Scott, J. P. (2019). Role Checklist Version 3: Participation and Satisfaction (RCv3). https://www.moho.uic.edu/productDetails.aspx?iid=6
Stamm, B. (2009). Professional quality of life measure: Compassion, satisfaction, and fatigue version 5 (ProQOL). https://proqol.org/ProQol_Test.html
Temkin-Greener, H., Gross, D., Kunitz, S. J., & Mukamel, D. (2004). Measuring interdisciplinary team performance in a long-term care setting. Medical Care, 42(5), 472-481. https://doi.org/10.1097/01.mlr.0000124306.28397.e2
Tinetti, M. E., Richman, D., & Powell, L. (1990). Falls efficacy as a measure of fear of falling. Journal of Gerontology, 45(6), P239-243. https://doi.org/10.1093/geronj/45.6.p239
Trockel, M., Bohman, B., Lesure, E., Hamidi, M. S., Welle, D., Roberts, L., & Shanafelt, T. (2018). A brief instrument to assess both burnout and professional fulfillment in physicians: Reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Academic Psychiatry, 42(1), 11-24. https://doi.org/10.1007/s40596-017-0849-3
U.S. Department of Health and Human Services. (n.d.). Health People 2030: Leading health indicators. https://health.gov/healthypeople/objectives-and-data/leading-health-indicators
van der Vaart, R., & Drossaert, C. (2017). Development of the Digital Health Literacy Instrument: Measuring a broad spectrum of health 1.0 and health 2.0 skills. Journal of Medical Internet Research, 19(1), e27. https://doi.org/10.2196/jmir.6709
Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care, 37(2), 126-139. https://doi.org/10.1097/00005650-199902000-00003
Vismara, L. A., Young, G. S., & Rogers, S. J. (2012). Telehealth for expanding the reach of early autism training to parents. Autism Research and Treatment, 2012, 121878. https://doi.org/10.1155/2012/121878
Washington Co. Family Caregiver Support Program. (n.d.). Washington Co. Family Caregiver Satisfaction Survey. https://www.oregon.gov/dhs/SENIORS-DISABILITIES/SUA/Documents/WA%20Co%20%20FCG%20Satisfaction%20Survey.pdf
Wehmeyer, M. L. (1999). A functional model of self-determination: Describing development and implementing instruction. Focus on autism and other developmental disabilities, 14(1), 53-61. https://doi.org/10.1177/108835769901400107
Wehmeyer, M. L., & Kelchner, K. (1995). The Arc's Self-Determination Scale (Adolescent Version). Arc of the United States.
Wehmeier P. M., Fox, T., Doerr, J.M., Schnierer, N., Bender, M., Nater, U.M. (2019). Development and validation of a brief measure of self-management competence: The Self-Management Self-Test (SMST). Therapeutic Innovation & Regulatory Science, 2168479019849879. https://doi.org.10.1177/2168479019849879
World Health Organization [WHO]. (1986). The 1st International Conference on Health Promotion, Ottawa 1986. https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference
World Health Organization [WHO] (1998). Well-being Measures in Primary Health Care/The Depcare Project. WHO Regional Office for Europe: Copenhagen.
World Health Organization [WHO]. (2001). International classification of functioning, disability and health. Geneva: Author.
World Health Organization [WHO]. (2004). The World Health Organization Quality of Life (WHOQOL) - BREF, 2012 revision. https://apps.who.int/iris/handle/10665/77773
World Health Organization [WHO]. (2006). Constitution of the World Health Organization (45th ed.). https://www.who.int/governance/eb/who_constitution_en.pdf
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist, 20(6), 649-655. https://doi.org/10.1093/geront/20.6.649
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