title: Understanding the value of emergency care: a framework incorporating stakeholder perspectives.
abstract: BACKGROUND
  In the face of escalating spending, measuring and maximizing the value of health services has become an important focus of health reform. Recent initiatives aim to incentivize high-value care through provider and hospital payment reform, but the role of the emergency department (ED) remains poorly defined.
  
  
  OBJECTIVE
  To achieve an improved understanding of the value of emergency care, we have developed a framework that incorporates the perspectives of stakeholders in the delivery of health services.
  
  
  METHODS
  A pragmatic review of the literature informed the design of this framework to standardize the definition of value in emergency care and discuss outcomes and costs from different stakeholder perspectives. The viewpoint of patient, provider, payer, health system, and society is each used to assess value for emergency medical conditions.
  
  
  RESULTS
  We found that the value attributed to emergency care differs substantially by stakeholder perspective. Potential targets to improve ED value may be aimed at improving outcomes or controlling costs, depending on the acuity of the clinical condition.
  
  
  CONCLUSIONS
  The value of emergency care varies by perspective, and a better understanding is achieved when specific outcomes and costs can be identified, quantified, and measured. Using this framework can help stakeholders find common ground to prioritize which costs and outcomes to target for research, quality improvement efforts, and future health policy impacting emergency care.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan; Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Sharp
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Enesha M
authors.initials: EM
authors.lastname: Cobb
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Dresden
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Richardson
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Amber K
authors.initials: AK
authors.lastname: Sabbatini
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Kori
authors.initials: K
authors.lastname: Sauser
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, Michigan.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Kocher
mesh_terms: D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards; D006298:Health Services Administration; D006302:Health Services Research; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction
keywords: emergency department utilization; health care administration; health policy; health services research; public health; value