title: Measuring value for low-acuity care across settings.
abstract: Increasing healthcare costs have created an emphasis on improving value, defined as how invested time, money, and resources improve health. The role of emergency departments (EDs) within value-driven health systems is still undetermined. Often questioned is the value of an ED visit for conditions that could be reasonably treated elsewhere such as office-based, urgent, and retail clinics. This paper presents a conceptual approach to assess the value of these low-acuity visits. It adapts an existing analytic model to highlight specific factors that impact key stakeholders' (patients, insurers, and society) assessments of the value of ED-based care compared with care in alternative settings. These factors are presented in 3 equations, 1 for each stakeholder, emphasizing how tangible and intangible benefits of care weigh against direct and indirect costs and how each perspective influences value. Aligning value among groups could allow stakeholders to influence each other and could guide rational change in the delivery of acute medical care for low-acuity conditions.
authors.affiliation: Department of Emergency Medicine, Georgetown University Hospital/Washington Hospital Center, Washington, DC, USA. sofie.r.morgan@emory.edu
authors.forename: Sofie Rahman
authors.initials: SR
authors.lastname: Morgan
authors.forename: Meaghan A
authors.initials: MA
authors.lastname: Smith
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pitts
authors.forename: Robert
authors.initials: R
authors.lastname: Shesser
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ward
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
mesh_terms: D000208:Acute Disease; D019985:Benchmarking / Q000191:economics* / Q000706:statistics & numerical data; D003657:Decision Making; D004526:Efficiency; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D017146:Models, Organizational; D017060:Patient Satisfaction; D014481:United States