Introduction: Patient assessment is a fundamental feature of non-emergency community paramedicine (CP) home visit programs. In the absence of a recognized standard for CP assessment, current assessment practices in CP programs are unknown. Without knowing what community paramedics are assessing, it is difficult to ascertain what should be included in patient care plans, whether interventions are beneficial, or whether paramedics are meeting program objectives. Our objective was to summarize the content of assessment instruments used in CP programs in order to describe the state of current practice. Methods: We performed an environmental scan of all CP programs in Ontario, Canada, and employed content analysis to describe current assessment practices in CP home visit programs. The International Classification on Functioning, Disability, and Health (ICF) was used to categorize and compare assessments. Each item within each assessment form was classified according to the ICF taxonomy. Findings were compared at the domain and sub-domain of the ICF. Results: Of 54 paramedic services in Ontario, 43 responded to our request for information. Of 24 services with CP home visit programs, 18 provided their intake assessment forms for content analysis. Assessment forms contained between 13 and 252 assessment items (median 116.5, IQR 134.5). Overall, most assessments included some content from each of the domains outlined in the ICF, including: Impairments of Body Functions, Impairments of Body Structures, Activity Limitation and Participation, and Environmental Factors. At the sub-domain level, only assessment of Impairments of the Functions of the Cardiovascular, Haematological, Immunological and Respiratory systems appeared in all assessments. Few CP home visit program assessments covered most ICF sub-domain categories and many items classified to specific categories were included in only a few assessments. Conclusion: CP home visit programs complete multi-domain assessments as part of patient intake. The content of CP assessments varied across Ontario, which suggests that care planning and resources may not be consistent. Current work on practice guidelines and paramedic training can build from descriptions of assessment practices to improve quality of care and patient safety. By identifying what community paramedics assess, evaluation of the quality of CP home visit programs and their ability to meet program objectives can be improved and benchmarks in patient care can be established.

There is wide recognition that patient and client assessment by community nurses is central to the provision of high quality care. It is also acknowledged that assessment in the home setting is a complex process requiring a wide range of knowledge and skills. This article identifies two distinct approaches to assessment that have emerged in different contexts around the world. These approaches comprise the formal, structured questionnaire-based assessment that has been developed particularly in response to the requirement to determine service eligibility and the informal, conversation-based assessment that draws on nursing concepts and theories. The article briefly traces the professional and policy influences that have shaped the development of these two approaches before turning to a critical analysis of selected empirical work that has examined their effectiveness. Research undertaken on the structured form of assessment has focused largely on issues of reliability. While the majority of studies indicate that this form of assessment is reliable in identifying patient need, some research highlights its failure to take account of patient and client perspectives. This raises questions about the appropriateness of the nursing interventions that are planned in response to a structured assessment. Less research attention has been devoted to exploring the conversation-based approach to assessment, but this body of work has drawn attention to the potential for practitioners to adopt a controlling influence over the assessment process. Reference is made to research in which the author has collaborated that illuminates the way in which two styles of conversation-based assessment impact differently on patients and clients. The article concludes by identifying the need for further research and argues that a key focus should be the ways in which assessment contributes to care planning and patient outcomes.