Development of a Conceptual Model for Management of

Acute Unscheduled Care in the U.S.

Jesse Pines, MD, MBA, MSCE

Gaetano Lotrecchiano, EdD, PhD

Mark Zocchi, MPH

Domain 1: Patient- and community- centered emergency care Domain 2: Integration of emergency care into the broader healthcare system Domain 3: Delivery of high quality emergency care Domain 4: Prepared to respond in times of public health emergencies

Sponsor

Objectives

• Conceptual Model for Acute Unscheduled Care

+ Emergency Care System

• Acute conditions

• Acute exacerbations of chronic conditions

• Policy Recommendations • Patient and community-centered

• Daily surge control

• Disasters and public health emergencies

Environmental Scan

Focus Group Sessions

Expert Panel / Delphi

Final Report & Recommendations

Project Plan

Draft Model

Asynchronous Synchronous

1. Patients 2. Acute Care Providers 3. Other Providers 4. Policymakers & Payers

Revised Model Final Model

Date of download: 10/8/2014

From: What Is Our Plan for Acute Unscheduled Care?

Ann Intern Med. 2013;158(12):907-909. doi:10.7326/0003-4819-158-12-201306180-00008

Comparison of U.S. health system outpatient visits, by setting and primary care specialty.

All data are from 2007 except for acute care visits, which are averaged over 2001–2004. Numbers in parentheses are references.

Figure Legend:

Copyright © American College of Physicians. All rights reserved.

Andersen, 1968

Andersen, R. A behavioral model of families’ use of health services. University of Chicago. Research Series 25. 1968.

Andersen & Newman, 1973

Andersen, 1968

Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society, 51(1), 95–124.

Aday and Andersen, 1974

Aday, L. A., & Andersen, R. (1974). A Framework for the Study of Access to Medical Care. Health Services Research, 9(3), 208–220.

Andersen revisited, 1995

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1–10.

Asplin, BR., Magid, DJ., Rhodes, KV., Solberg, LI, Lurie, N., Camargo, CA., A Conceptual Model of Emergency Department Crowding. Annals of Emergency Medicine. 2003;42:173-180.

Asplin, 2003

Smulowitz, 2013

Smulowitz, P. B., Honigman, L., & Landon, B. E. (2013). A novel approach to identifying targets for cost reduction in the emergency department. Annals of Emergency Medicine, 61(3), 293–300. doi:10.1016/j.annemergmed.2012.05.042

Method: Concept Mapping

• Method. Four distinct steps to produce an output map that will inform a theoretical conceptual framework.

Kane, M., & Goldman, A. (2014). Everythiong is connected: Using group concept mapping to articulate conceptual relationships. Paper presented at the Science of Team Science Conference, Austin, TX.

Stage 1: Planning

• Planning stage--the investigators will design a focus prompt based on the key knowledge outcome desired that answers the main research question of the study

• EXAMPLE FOCUS PROMPT: A specific action that the North County Department of Social Services could implement over the next five years to improve its culture and level of service is…

Stage 2: Brainstorming

• Each participant will supply as many answers as desired to the single prompt generating large sets of relevant topics based one the one research question prompt.

• These are anonymously provided through the survey instrument

• The statements are shared collectively are are captured through an electronic portal in the Global MAXTM software accessible through any Internet connection.

Stage 3: Sorting

• Statements gathered from the brainstorming step are sorted into related “piles” of information for idea synthesis by the investigators.

• Complex or multiple meaning statements are deconstructed and structured by a process of sorting.

Stage 4: Rating and Mapping

• Rating.

– To understand the relationship between concepts, statements are then rated using a process that pairs concepts together onto a matrix that will ultimately inform the conceptual map of the relationships between concepts using multidimensional scaling (MDS)

• Step 4. Mapping, Clustering, and Labeling. – Mapping of the knowledge entities provides visualization of

relationships based on clustering of statements of greatest shared meaning shown in proximal spatial relationship.

– Knowledge clusters are defined measuring the proximity between entities and clustering them based on their relative strengths

Analysis: Labeling Expert Panel Delphi

Kagan, J., Kane, M., Quinlan, K., Rosas, S., & Trochim, W. (2009). Developing a conceptual framework for an evaluation system for the NIAID HIV/AIDS clinical trials network. Health Research Policy and Systems, 7, 12.

Environmental Scan

Focus Group Sessions

Expert Panel / Delphi

Final Report & Recommendations

Questions / Comments ?

Draft Model

Asynchronous Synchronous

1. Patients 2. Acute Care Providers 3. Other Providers 4. Policymakers & Payers

Revised Model Final Model