PACE Framework

The PACE Framework guides the measurement and evaluation of occupational therapy services delivered through telehealth. This framework aims to demonstrate the distinct value of such services by evaluating meaningful participation, equitable access to services, financial value, and the experiences of clients and practitioners.

The framework consists of four interconnected domains: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. Within the Population and Health Outcomes domain, occupational therapy outcomes include occupational performance, participation, prevention, health promotion, care coordination, quality of life, role competence, self-advocacy, and well-being. The Access for All Clients domain reflects occupational therapy’s commitment to diversity, equity, and inclusion and, accordingly, occupational therapy practitioners are encouraged to identify and address barriers to accessing telehealth services to support clients’ participation. The Costs and Cost Effectiveness domain focuses on client and practitioner expenses, cost savings, service utilization, and their relationships with long-term outcomes. The Experiences domain considers the extent to which telehealth sessions address clients’ everyday activities in authentic contexts and captures the satisfaction and acceptability of services among clients, caregivers/care partners, and occupational therapy practitioners.

These domains are distinct but overlapping, rather than following a fixed sequence. For example, technology usability relates to access, while satisfaction with technology also relates to service experiences. Similarly, reduced travel may represent both a cost saving and a perceived benefit that influences satisfaction. Caregiver/care partner involvement also links service experiences with successful access to and utilization of telehealth services.

The PACE Framework can guide research, practice, and program evaluation involving telehealth and hybrid service delivery. Measures may include questionnaires, observations, client or caregiver reports, and reviews of clinical records. It is a flexible menu, not a compulsory checklist, allowing users to evaluate selected components or all four domains.