{
  "abstract": "Objective Design Traditional encounter-based analyses overlook downstream costs and complications that follow emergency department (ED) care. To enable more comprehensive evaluations, we developed standardised episode of care definitions for five common, high-cost conditions: chest pain, congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD) and suicidality.A two-round modified Delphi panel study was conducted following a literature review and evidence synthesis. Using structured surveys with anonymous feedback, panellists rated candidate criteria. To be retained in the final episode definitions, criteria were required to meet a predefined validity threshold without panellist disagreement. Data were analysed descriptively, and meeting deliberations were recorded and reviewed thematically.Setting Virtual, supported by an online survey platform.Participants A multidisciplinary panel of 11 experts in emergency medicine and relevant clinical specialties with 9 members participating in each round.Outcomes Criteria to determine inclusion, exclusion (including pre-trigger, post-trigger and event exclusion) and risk-adjustment standards for constructing ED-based episodes of care.Results Candidate criteria were presented to the panel by condition: 30 for chest pain, 54 for CHF, 30 for COPD, 79 for pneumonia and 375 for suicidality. Following deliberations and re-rating, the number of valid criteria was reduced, primarily in the episode exclusion category. Thematic analysis highlighted trade-offs between episode exclusion criteria and the use of risk adjustment to account for heterogeneity.Conclusions Operational definitions for ED-based episodes of care for five conditions were established. These may support healthcare administrators, policymakers and researchers in evaluating variation in ED care delivery and its downstream cost and outcomes.",
  "authors": [
    {
      "affiliations": [
        "VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA",
        "Departments of Emergency Medicine and Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA",
        "Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA"
      ],
      "name": "Keith E Kocher"
    },
    {
      "affiliations": [
        "VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA"
      ],
      "name": "Aimee D Myers"
    },
    {
      "affiliations": [
        "Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA"
      ],
      "name": "Tracy H Urech"
    },
    {
      "affiliations": [
        "Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA",
        "Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "Steven Asch"
    },
    {
      "affiliations": [
        "VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA",
        "Pulmonary Section, Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA",
        "Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA",
        "Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA"
      ],
      "name": "Andrew Admon"
    },
    {
      "affiliations": [
        "Mental Health Service Line, VA Connecticut Healthcare System, West Haven, Connecticut, USA"
      ],
      "name": "Brian S Fuehrlein"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Cameron J Gettel"
    },
    {
      "affiliations": [
        "National Emergency Medicine Office, VHA Healthcare Operations Center, Washington, District of Columbia, USA",
        "Department of Emergency Medicine, UCLA Medical School, Los Angeles, California, USA"
      ],
      "name": "Neil Patel"
    },
    {
      "affiliations": [
        "US Acute Care Solutions LLC, Canton, Ohio, USA",
        "Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA"
      ],
      "name": "Jesse M Pines"
    },
    {
      "affiliations": [
        "Integrated Veteran Care Office, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, USA"
      ],
      "name": "Nicholas S Potochny"
    },
    {
      "affiliations": [
        "Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA"
      ],
      "name": "Amber K Sabbatini"
    },
    {
      "affiliations": [
        "Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA",
        "Division of Epidemiology, Department of Internal Medicine, The University of Utah School of Medicine, Salt Lake City, Utah, USA",
        "Division of Health System Innovation and Research, Department of Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Megan Vanneman"
    },
    {
      "affiliations": [
        "Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA",
        "Departments of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA"
      ],
      "name": "Michael J Ward"
    },
    {
      "affiliations": [
        "Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA",
        "Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA",
        "Department of Emergency Medicine (Affiliated), Stanford University School of Medicine, Stanford, California, USA"
      ],
      "name": "Anita Vashi"
    }
  ],
  "title": "Establishing criteria for emergency department-based episode of care definitions: a modified Delphi study",
  "uid": "92f28e34-6bbf-57e7-b1bf-7ed9ce82069f"
}