Post on 25-Jun-2020
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• acutecaremodel@gwu.edu
GW Office for Clinical Practice Innovation
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
GW Office for Clinical Practice Innovation
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
GW Office for Clinical Practice Innovation
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.
GW Office for Clinical Practice Innovation
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
GW Office for Clinical Practice Innovation
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
GW Office for Clinical Practice Innovation
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)
Individual‐level factors• Personal resources• Individual characteristics• Personal and family
preparedness
Environment
GW Office for Clinical Practice Innovation
Community‐level factors• Neighborhood characteristics• Community resources• Public health & preparedness• Economic resources
Immediate Less Immediate
High Severity
Lower Severity
Individual‐level factors• Personal resources• Individual characteristics• Personal and family
preparedness
Injury and illness:
Heart attack Cancer
Laceration Skin irritation
Injury and illness
Environment
GW Office for Clinical Practice Innovation
Community‐level factors• Neighborhood characteristics• Community resources• Public health & preparedness• Economic resources
Individual‐level factors• Personal resources• Individual characteristics• Personal and family
preparedness
Injury and illness
Policy
Policy• Emergency Medical Treatment &
Labor Act (EMTALA)• Health insurance reform
GW Office for Clinical Practice Innovation
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
GW Office for Clinical Practice Innovation
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
Individual‐level factors• Personal resources• Individual characteristics• Personal and family
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
16
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.
©2014ConceptSystems,Inc.
Your Contributions via Brainstorming
• Expands the value of the model
• Ensures a saturation of the topic
• Collectively authors the feedback
17
©2014ConceptSystems,Inc.
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
18
©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
GW Office for Clinical Practice Innovation