A Conceptual Model for Episodes of Acute, Unscheduled Care

Pines, Jesse M.; Lotrecchiano, Gaetano R.; Zocchi, Mark S.; Lazar, Danielle; Leedekerken, Jacob B.; Margolis, Gregg S.; Carr, Brendan G.

doi:10.1016/j.annemergmed.2016.05.029

Cited by 47 publications

(37 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our review was informed by a conceptual model ( Figure S1) that drew on previously published models. 20,21 We followed a standard protocol for all steps of this review (PROSPERO: CRD42018087660). Our full report, referenced earlier, is available at https://www.hsrd.research.va.…”

Section: Methodsmentioning

confidence: 99%

Emergency Department Interventions for Older Adults: A Systematic Review

Hughes

Freiermuth

Shepherd‐Banigan

et al. 2019

J American Geriatrics Society

109

View full text Add to dashboard Cite

OBJECTIVES To evaluate the effect of emergency department (ED) interventions on clinical, utilization, and care experience outcomes for older adults. DESIGN A conceptual model informed, protocol‐based systematic review. SETTING Emergency Department (ED). PARTICIPANTS Older adults 65 years of age and older. METHODS AND MEASUREMENT Medline, Embase, CINAHL, and PsycINFO were searched for English‐language studies published through December 2017. Studies evaluating the use of one or more eligible intervention strategies (discharge planning, case management, medication safety or management, and geriatric EDs including those that cited the 2014 Geriatric ED Guidelines) with adults 65 years of age and older were included. Studies were classified by the number of intervention strategies used (ie, single strategy or multi‐strategy) and key intervention components present (ie, assessment, referral plus follow‐up, and contact both before and after ED discharge [“bridge”]). The effect of ED interventions on clinical (functional status, quality of life [QOL]), patient experience, and utilization (hospitalization, ED return visit) outcomes was evaluated. RESULTS A total of 2000 citations were identified; 17 articles describing 15 unique studies (9 randomized and 6 nonrandomized) met eligibility criteria and were included in analyses. ED interventions showed a mixed pattern of effects. Overall, there was a small positive effect of ED interventions on functional status but no effects on QOL, patient experience, hospitalization at or after the initial ED index visit, or ED return visit. CONCLUSION Studies using two or more intervention strategies may be associated with the greatest effects on clinical and utilization outcomes. More comprehensive interventions, defined as those with all three key intervention components present, may be associated with some positive outcomes.

show abstract

Section: Methodsmentioning

confidence: 99%

Emergency Department Interventions for Older Adults: A Systematic Review

Hughes

Freiermuth

Shepherd‐Banigan

et al. 2019

J American Geriatrics Society

109

View full text Add to dashboard Cite

show abstract

“…Strong problem-solving skills are particularly important in the United States where acute care delivery is often fragmented, and there is poor availability of access to integrated, longitudinal care settings in many communities. 19 Certainly, the absence of good problem-solving skills given the complex Table 2 Physician Factors Important to Top Clinical Performance in EM Residency Attributes Good common sense-Physician has sound judgment.…”

Section: Discussionmentioning

confidence: 99%

Factors Important to Top Clinical Performance in Emergency Medicine Residency: Results of an Ideation Survey and Delphi Panel

Pines

Alfaraj

Batra

et al. 2018

AEM Education and Training

Self Cite

View full text Add to dashboard Cite

Objectives: We explore attributes, traits, background, skills, and behavioral factors important to top clinical performance in emergency medicine (EM) residency. Methods:We used a two-step process-an ideation survey with the Council of Emergency Medicine Residency Directors and a modified Delphi technique-to identify: 1) factors important to top performance, 2) preresidency factors that predict it, and 3) the best ways to measure it. In the Delphi, six expert educators in emergency care assessed the presence of the factors from the ideation survey results in their top clinical performers. Consensus on important factors that were exemplified in >60% of top performers were retained in three Delphi rounds as well as predictors and measures of top performance. Results:The ideation survey generated 81 responses with ideas for each factor. These were combined into 89 separate factors in seven categories: attributes, personal traits, emergency department (ED)-specific skills and behaviors, general skill set, background, preresidency predictors, and ways to measure top performance. After three Delphi rounds, the panel achieved consensus on 20 factors important to top clinical performance. This included two attributes, seven traits, one general skill set, and 10 ED-specific skills and behaviors. Interview performance was considered the sole important preresidency predictor and clinical competency committee results the sole important measure of top performance. Conclusion:Our expert panel identified 20 factors important to top clinical performance in EM residency. Future work is needed to further explore how individuals learn and develop these factors. U nderstanding the development of expertise and top performance has been the subject of considerable research across fields from chess, to sports, to delivering comedy routines. 1 A subset of this literature focuses on medicine, specifically assessing factors linked with top clinical performance and learning as

show abstract

“…Emergency care may thus represent the true market preferences of patients, reflecting the social and individual determinants of health as well as individual preferences for care delivery (Pines et al. ). Given our findings, emergency care may represent a potential use case for a novel, perhaps additional, means of attribution and/or payment for health outcomes that incentivizes regional cooperation to improve population health.…”

Section: Discussionmentioning

confidence: 99%