title: Exploring real-time patient decision-making for acute care: a pilot study.
abstract: BACKGROUND
  Research has described emergency department (ED) use patterns in detail. However, evidence is lacking on how, at the time a decision is made, patients decide if healthcare is required or where to seek care.
  
  
  METHODS
  Using community-based participatory research methods, we conducted a mixed-methods descriptive pilot study. Due to the exploratory, hypothesis-generating nature of this research, we did not perform power calculations, and financial constraints only allowed for 20 participants. Hypothetical vignettes for the 10 most common low acuity primary care complaints (cough, sore throat, back pain, etc.) were texted to patients twice daily over six weeks, none designed to influence the patient's decision to seek care. We conducted focus groups to gain contextual information about participant decision-making. Descriptive statistics summarized responses to texts for each scenario. Qualitative analysis of open-ended text message responses and focus group discussions identified themes associated with decision-making for acute care needs.
  
  
  RESULTS
  We received text survey responses from 18/20 recruited participants who responded to 72% (1092/1512) of the texted vignettes. In 48% of the vignettes, participants reported they would do nothing, for 34% of the vignettes participants reported they would seek care with a primary care provider, and 18% of responses reported they would seek ED care. Participants were not more likely to visit an ED during "off-hours." Our qualitative findings showed: 1) patients don't understand when care is needed; 2) patients don't understand where they should seek care.
  
  
  CONCLUSIONS
  Participants were unclear when or where to seek care for common acute health problems, suggesting a need for patient education. Similar research is necessary in different populations and regarding the role of urgent care in acute care delivery.
authors.affiliation: Southern California Kaiser Permanente, Department of Research and Evaluation, Pasadena, California ; University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Sharp
authors.affiliation: University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Family Medicine, Ann Arbor, Michigan.
authors.forename: Tammy
authors.initials: T
authors.lastname: Chang
authors.affiliation: University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan ; Center for Clinical Management Research, Ann Arbor VA Health System, Ann Arbor, Michigan.
authors.forename: Enesha
authors.initials: E
authors.lastname: Cobb
authors.affiliation: University of Michigan, Department of Family Medicine, Ann Arbor, Michigan.
authors.forename: Weyinshet
authors.initials: W
authors.lastname: Gossa
authors.affiliation: Friends of Parkside, Detroit, Michigan.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Rowe
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kohatsu
authors.affiliation: University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan ; Center for Clinical Management Research, Ann Arbor VA Health System, Ann Arbor, Michigan.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
mesh_terms: D000208:Acute Disease / Q000523:psychology* / Q000628:therapy; D000328:Adult; D055812:Community-Based Participatory Research; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010865:Pilot Projects; D055815:Young Adult