Adam L Sharp1, Enesha M Cobb2, Scott M Dresden3, Derek K Richardson4, Amber K Sabbatini5, Kori Sauser6, Keith E Kocher7. 1. 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. 2. Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan. 3. Department of Emergency Medicine, Northwestern University, Chicago, Illinois; Center for Healthcare Studies, Northwestern University, Chicago, Illinois. 4. Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon. 5. Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan. 6. 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. 7. Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, Michigan.
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. OBJECTIVES: 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. CONCLUSION: 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.
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. OBJECTIVES: 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. CONCLUSION: 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: Adam L Sharp; Brian Z Huang; Tania Tang; Ernest Shen; Edward R Melnick; Arjun K Venkatesh; Michael H Kanter; Michael K Gould Journal: Ann Emerg Med Date: 2017-07-21 Impact factor: 5.721
Authors: Michael M Neeki; Fanglong Dong; Leigh Avera; Tan Than; Rodney Borger; Joe Powell; Reza Vaezazizi; Richard Pitts Journal: West J Emerg Med Date: 2016-10-04