A multicriteria vulnerability index for equitable resource allocation in public health funding.

SETTING: This paper describes an action research project with the Centre universitaire intégré de santé et de services sociaux - Capitale Nationale (CIUSSS-CN) who identified a need to assess vulnerability in their territories in order to ensure equitable distribution of the Integrated Perinatal and Early Childhood Services (SIPPE) program funds. The objective was to design and validate a multicriteria model to provide a more accurate portrait of vulnerability based on recent social realities. INTERVENTION: Our multidisciplinary research team of 7 members included experts in analytics, decision aiding, and community and public health. In collaboration with 6 CIUSSS-CN professionals, we co-constructed, during 9 workshops, a multicriteria model to aggregate the multiple dimensions of vulnerability. We used a value-focused thinking approach and applied the method MACBETH assisted by a geographic information system. OUTCOMES: Criteria, scales, and weights were validated and led to a vulnerability score for each CIUSSS-CN territory. This score provides a more accurate portrait of territorial disparities based on data and the participants' experience. The model was implemented in a dynamic user-friendly tool and serves to support decision-makers in the resource allocation process. Knowledge transfer was conducted during and after the process. IMPLICATIONS: This multidisciplinary research has served to anchor public health funding in local realities, with an emphasis on equity and stakeholder engagement. Our mixed-method approach integrating qualitative and quantitative data is adaptable to other contexts. Our results can enhance intervention effectiveness and allow for a better response to the needs of the population targeted by the SIPPE program.

RéSUMé: LIEU: Cet article décrit un projet de recherche-action avec le Centre Universitaire Intégré de Santé et de Services Sociaux - Capitale Nationale (CIUSSS-CN) qui a identifié un besoin d'évaluer la vulnérabilité sur son territoire afin d'assurer une distribution équitable des fonds du programme des Services Intégrés en Périnatalité et pour la Petite Enfance (SIPPE). L'objectif était de concevoir et de valider un modèle multicritère permettant de dresser un portrait plus précis de la vulnérabilité en fonction des réalités sociales récentes. INTERVENTION: Notre équipe de recherche multidisciplinaire de 7 membres comprenait des experts en analytique, en aide à la décision et en santé publique et communautaire. En collaboration avec 6 professionnelles du CIUSSS-CN, nous avons co-construit, au cours de 9 ateliers, un modèle d'évaluation multicritère pour agréger les multiples dimensions de la vulnérabilité. Nous avons utilisé une approche de modélisation centrée sur les valeurs et appliqué la méthode MACBETH assistée par un système d'information géographique. RéSULTATS: Les critères, les échelles et les pondérations ont été validés et ont conduit à un score de vulnérabilité pour chaque territoire de la CIUSSS-CN. Ce score fournit un portrait plus précis des disparités territoriales basé sur les données et la connaissance qu'ont les participants du terrain. Le modèle a été implémenté dans un outil dynamique et convivial servant à soutenir les décideurs dans le processus d'allocation des ressources. Le transfert de connaissances a été effectué tout au long du et après le processus. IMPLICATIONS: Cette recherche multidisciplinaire a permis d'ancrer le financement de la santé publique dans les réalités locales, en mettant l'accent sur l'équité et l'engagement des parties prenantes. Notre approche mixte intégrant des données qualitatives et quantitatives est adaptable à d'autres contextes. Nos résultats peuvent améliorer l'efficacité des interventions et permettre de mieux répondre aux besoins de la population ciblée par le programme SIPPE.

Televideo assessment using Functional Reach Test and European Stroke Scale.

This study explored the equivalence of physical function assessment by physical therapists (PTs) during face-to-face and remote administration of the European Stroke Scale (ESS) and the Functional Reach Test (FRT) to 26 subjects with a history of stroke. Patients were randomized to remote or face-to-face administration groups. Each patient was simultaneously rated by both the face-to-face and remote PTs. The PTs were blinded to each other's results. Equivalence was set at the 95% limits of agreement. When the face-to-face PT directed the patient, the two PTs reported equivalent values in more than 90% of the patients for the FRT and for all ESS components, with the exception of gait (83%) and maintaining leg position (85%). When the remote PT directed the patient, the two PTs reported equivalent values in more than 90% of the patients for the FRT and more than 83% for all ESS components. Televideo assessment of function by PTs is substantially equivalent to a face-to-face encounter.

Technical feasibility of teleassessments for rehabilitation.

BACKGROUND: technical feasibility was evaluated for conducting standard motor assessment instruments in a remote setting. Remote assessment was compared to co-located assessment for five clinical evaluation instruments: joint range-of-motion (ROM), manual muscle test (MMT), Berg sit-to-stand, Berg forward reach, and timed up and go (TUG). METHODS: co-located and remote rooms were in the same building connected by broadband video and audio. Ten subjects without impairments participated, but were given simulated impairments to mimic the patient population commonly seen in rehabilitation clinics. One therapist performed all co-located testing while another performed all remote assessments. Measurements followed standard clinical methods. Data were analyzed using repeated measures ANOVA and paired t-tests. RESULTS: no differences were found between co-located and remote assessments except for some cases using screen-based ROM measures. Remote ROM tests using snapshots and a virtual goniometer were preferred. A digital dynamometer added no additional information to a visually-based remote MMT assessment.

Telerehabilitation consultations for clients with neurologic diagnoses: cases from rural Minnesota and American Samoa.

Telerehabilitation is the provision of rehabilitation services at a distance using electronic information and communication technologies. This paper describes two clinical programs that utilize videoconferencing to provide rehabilitation specialist consultations to individuals living in remote areas. Needs assessments for the two areas revealed that local clinicians were interested in access to specialty consultation. Administrative processes and a data collection tool were developed for these programs. High speed videoconferencing that allows for real-time audio and video interaction was used. Each consultation includes the patient, the local caregivers and specialists from our facilities interacting via videoconferencing. A total of 117 telerehabilitation encounters have been completed. All consultations resulted in changes to the plan of care. Clinicians who participated in the projects consistently rated the clinical effectiveness of teleconsults as good or excellent. Thirty-eight consultations have been neurologic in nature. Of that set, 25 of the visits were initial assessments, and thirteen were follow-up visits. Two case studies of individuals with neurologic diagnoses are presented. Recommendations to others who are providing rehabilitation services via telehealth technologies are included. The authors conclude that the care of individuals with neurologic issues can be augmented and supported via specialty consultation using telehealth technology.