title: A Conceptual Model for Episodes of Acute, Unscheduled Care.
abstract: We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care. In accordance with this information, we then drafted a preliminary conceptual model and collected stakeholder feedback, using online focus groups and concept mapping. Two technical expert panels reviewed the draft model, examined the stakeholder feedback, and discussed ways the model could be improved. After integrating the experts' comments, we solicited public comment on the model and made final revisions. The final conceptual model includes social and individual determinants of health that influence the incidence of acute illness and injury, factors that affect care-seeking decisions, specific delivery settings where acute care is provided, and outcomes and costs associated with the acute care system. We end with recommendations for how researchers, policymakers, payers, patients, and providers can use the model to identify and prioritize ways to improve acute care delivery.
authors.affiliation: Departments of Emergency Medicine and Health Policy and Management, The George Washington University, Washington, DC; Office for Clinical Practice Innovation, George Washington School of Medicine and Health Science, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Departments of Clinical Research and Leadership and Pediatrics, The George Washington University, Washington, DC; Office for Clinical Practice Innovation, George Washington School of Medicine and Health Science, Washington, DC.
authors.forename: Gaetano R
authors.initials: GR
authors.lastname: Lotrecchiano
authors.affiliation: Office for Clinical Practice Innovation, George Washington School of Medicine and Health Science, Washington, DC. Electronic address: mzocchi@gwu.edu.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Zocchi
authors.affiliation: Office for Clinical Practice Innovation, George Washington School of Medicine and Health Science, Washington, DC.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lazar
authors.affiliation: Office for Clinical Practice Innovation, George Washington School of Medicine and Health Science, Washington, DC.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Leedekerken
authors.affiliation: Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Margolis
authors.affiliation: Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC; Sidney Kimmel Medical College, Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration*; D017144:Focus Groups; D006291:Health Policy; D006801:Humans; D008962:Models, Theoretical