of a Model for Management of Acute Unscheduled Care in the ... · GW Office for Clinical Practice Innovation Acute Care System Demand Setting Choice Acute Care Services Delivery Acute

Development of a Conceptual Model for Management of

Acute Unscheduled Care in the U.S.

George Washington UniversityConcept Systems, Inc

GW Office for Clinical Practice Innovation

Project Information

Project Page• http://smhs.gwu.edu/acutecare

Focus Prompt• “An additional issue that needs to be addressed in this model of acute care management is…”

Project Email• [email protected]


What is a Conceptual Model?

• Diagram to help describe a problem, system, or phenomenon

– Concepts (boxes)– Causal pathways (arrows to show relationships)

• Used for:– Policy building– Research– Systems planning


Structures of Care

Processes of Care Outcomes

Donabedian, A. (1988). "The quality of care: How can it be assessed?"JAMA 121 (11): 1145–1150.

Example 1


Example 2

Agency for Healthcare Research and Quality. “Closing the Quality Gap: Series: Bundled Payment: Effects on Health Care Spending and Quality.” Aug 24 2012.


Definitions of Acute Care and Settings

• Unscheduled– Illness or injury– Exacerbation of chronic disease

• Delivered in a variety of settings– Emergency departments, hospitals, health

centers, community clinics, doctor’s offices, urgent care, retail clinics, telemedicine, home health

Environment Acute Care System Outcomes

Individual and community factors that lead to or prevent people from getting sick and hurt

Medical care resources available, and how people use them when sick or hurt

What happens to people after they get medical care

Draft Conceptual Model of Acute Unscheduled Care in the U.S.(outline)

Environment


Individual‐level factors• Personal resources• Individual characteristics• Personal and family

preparedness

Individual‐level factors• Personal resources (health insurance, health literacy,

family support)• Individual characteristics (age, gender, race/ethnicity,

education, prior medical history).• Personal and family preparedness (disaster planning,

communication, family support)

Environment


Community‐level factors• Neighborhood characteristics• Community resources• Public health & preparedness• Economic resources

Community‐level factors:• Neighborhood characteristics (crime and

violence, housing, environmental pollution)• Community resources (rural/suburban/urban,

access to transportation, recreation options)• Public health and preparedness (vaccination

campaigns, flu readiness, disaster planning)• Economic resources (poverty, employment,

affordable housing, food security)


preparedness

Environment



Immediate Less Immediate

High Severity

Lower Severity


preparedness

Injury and illness:

Heart attack Cancer

Laceration Skin irritation

Injury and illness

Environment




preparedness

Injury and illness

Policy

Policy• Emergency Medical Treatment &

Labor Act (EMTALA)• Health insurance reform


Acute Care System

Demand

Setting Choice

Acute Care Services Delivery

Acute Care system• Demand (injury and illnesses)• Service supply (providers, facilities, technologies)• Setting choice (clinics, doctor’s offices, emergency

departments, urgent care, telemedicine etc.)‐ This also includes avoiding or not seeking acute care

• Acute care services delivery (blood tests, x‐rays, medications, procedures)

• Care transitions (coordination between two or more settings)

Service Supply

Injury and illness

Care Transitions

Policy

Outcomes


Individual outcomes• Functional outcomes• Symptom control• Quality of care• Experience• Costs• Survival

Population health • Life expectancy• Incidence of disease• Disparities

Outcomes• Functional outcomes

⁻ Return to work⁻ Mobility

• Symptom Control‐ Pain relief‐ Relief from shortness of breath

• Quality of care‐ Patient safety‐ Effective care

• Experience‐ Satisfaction with care

• Healthcare Costs‐ Total costs, out of pocket expenses

• Survival‐ 30 day mortality following AMI

• Population health‐ Life expectancy‐ Incidence of disease‐ Disparities

Environment Acute Care System Outcomes

Policy


preparedness

Community‐level factors• Neighborhood

characteristics• Community resources• Public health &

preparedness• Economic resources

Demand

Care Transitions

Setting Choice

Acute Care Services Delivery

Service SupplyIndividual outcomes• Functional outcomes• Symptom control• Quality of care• Experience• Costs• Survival

Population health • Life expectancy• Incidence of disease• Disparities

Injury and illness

©2014ConceptSystems,Inc.15

Online Focus GroupsMary Kane, Concept Systems

©2014ConceptSystems,Inc.

Overview of GCM Methodology Steps

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Planning: Planners and key issue advisors develop a focus prompt andidentify participants

Idea Generation: Communities of interest and expertise are identified, and respond with brainstormed ideas

Structuring: Communities of interest and expertise sort and rate the results of the idea development, authoring the structure and value domain of the issue

Representation: Compute the maps, pattern matches and “go zones,”and prepare them for interpretation by communities of interest.

Interpretation and Use: Strategies and tactics for action follow directly from the interpretation of the results. Pattern matches and go zones help build consensus on action.


Your Contributions via Brainstorming

• Expands the value of the model

• Ensures a saturation of the topic

• Collectively authors the feedback

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Standard Brainstorming Rules

• Keep the focus on task, by using the focus prompt as guide

• Any input addressing the topic is good

• Via CS website: contribute content as clearly as possible

• Editing will take place later, for understandability of content for the next steps

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©2014ConceptSystems,Inc.19

Online Brainstorming

Next steps

Start Brainstorming (direct link)• https://www.conceptsystemsglobal.com/AcuteUnscheduleCare/brainstorm

– Brainstorming link also found on the project page: (http://smhs.gwu.edu/acutecare)

Sorting and Rating‐ Will open after brainstorming is completed by all focus groups


Documents

of a Model for Management of Acute Unscheduled Care in the ... · GW Office for Clinical Practice Innovation Acute Care System Demand Setting Choice Acute Care Services Delivery Acute