Development of a Conceptual Model for Management of Acute Unscheduled Care in the US

In today’s healthcare system, patients have a variety of options in seeking healthcare. However, little research or data infrastructure exists to help inform consumers seeking care to make informed decisions about where to find the acute care resources that they need. Patients have to make complex choices about their healthcare without having the information needed to make informed decisions.

One in five Americans makes at least one visit to the emergency department (ED) each year. Over the past decade, the increase in ED utilization has outpaced growth of the general population, despite a national decline in the total number of ED facilities.

Many factors influence when and why people go to the emergency department for care. Some of those factors are personal, like an individual’s specific health condition; where they prefer to get care; how easy it is for them to get to the places where and when care is available; and what support they have from family and friends. Other factors are related to the communities where people live, like what options are available for care; the quality of that care; and how easy it is to get the other things people need to stay healthy, like housing, food and support from their community.

The increased utilization of EDs has resulted in recent substantial effort focused on controlling the costs of healthcare including the development of novel payment models that reward health delivery systems that can deliver high-quality care at low costs. A part of this dialogue has focused on decreasing emergency department utilization given the higher costs of treatment in the emergency department for unscheduled primary care treatable conditions.

While decreasing ED utilization may provide cost saving benefits, it may not translate into improved health outcomes unless infrastructure is added that can fill that gap. ED utilization is a direct reflection of community health status and the underlying system of care that is in place to support the health of the population. That is, patients tend to utilize the ED due to a lack of adequate alternative community health resources.

Community health resources can include many services, including public sources of information to foster informed decisions, primary and preventative health care, dental care, and treatment options for mental health and substance abuse conditions. EDs are increasingly treating a multitude of conditions, resulting in higher costs. Many research studies have pointed to a critical need for improved coordination of services between outpatient and emergency department health care providers.

The ECCC seeks to integrate acute care delivery into the broader healthcare system, and promote coordination between all providers of care to ensure a system that is patient- and community- centered. Without a model in place, patients and providers are unable to make informed decisions regarding unscheduled acute care options.

The ECCC contracted with the George Washington University to develop a Conceptual Model for Management of Acute Unscheduled Care in the US​. This model addresses issues facing the acute care system, from disaster and public health emergencies to day-to-day issues from the perspective of patients, providers, administrators, and payers. The model captures the social and individual determinants of health that influence acute illness and injury, describes care-seeking decisions, care delivery settings, transitions in care, and how quality care leads to differences in clinical outcomes and costs.