DEVELOPMENT AND EVALUATION OF BOUNDARY OBJECTS IN THE HETEROGENEOUS DOMAIN OF COMPLEX CHRONIC CONDITIONS

Abstract

Complex and chronic health conditions with multiple diagnoses and lacking in clinical practice guidelines often require a multidisciplinary care management scheme. Research has shown that the domain knowledge for these conditions is multidisciplinary, inconsistent, nonstandardized and poorly categorized making them heterogeneous and consequently challenging for collaborative work. The application of the boundary objects approach has come to the forefront as a way of closing communication gaps in collaborative work. There are limited research efforts in the application of boundary objects in the health care field and almost none in the area of complex chronic conditions. Research investigation of the application of boundary objects in heterogeneous domains is also limited. The primary objective(s) of this thesis is (are) to develop, test and evaluate a model and a methodology for creating boundary objects in the heterogeneous domain of complex chronic conditions. The methodology in this research applies a two-staged approach for enabling interoperability in the domain. The first stage is the development of a controlled vocabulary as a boundary object and the second stage of the two-staged approach is the development of an ontology as a boundary object to generate syntactic, semantic and pragmatic levels of interoperability in the dynamic domain. Towards these objectives, the boundary objects developed in the study satisfy certain unique requirements, namely to, have pragmatic boundaries, be dynamic in nature and be in standardized forms. To the best of our knowledge, this research is the first to investigate the development of boundary objects in the heterogeneous domain of complex chronic conditions. The outcome of this research is the development of a model for the generation of boundary objects to enhance communication among multidisciplinary clinicians. The model is developed in the heterogeneous domain of two complex chronic health conditions, namely, multiple chemical sensitivity and chronic pain. A testing and an evaluation process conducted in this research demonstrates that a high percentage of clinicians (>80%) agree on the overall usefulness of the boundary objects developed in this research. The results from the research are promising in terms of the potential applications of boundary objects in closing communication gaps in the multidisciplinary management of complex conditions.