TY - JOUR
T1 - Understanding the value of emergency care
T2 - A framework incorporating stakeholder perspectives
AU - Sharp, Adam L.
AU - Cobb, Enesha M.
AU - Dresden, Scott M.
AU - Richardson, Derek K.
AU - Sabbatini, Amber K.
AU - Sauser, Kori
AU - Kocher, Keith E.
PY - 2014/9
Y1 - 2014/9
N2 - 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.
AB - 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.
KW - emergency department utilization
KW - health care administration
KW - health policy
KW - health services research
KW - public health
KW - value
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U2 - 10.1016/j.jemermed.2014.04.017
DO - 10.1016/j.jemermed.2014.04.017
M3 - Article
C2 - 24881891
AN - SCOPUS:84906934268
SN - 0736-4679
VL - 47
SP - 333
EP - 342
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 3
ER -