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Public Health. 2018 Apr;157:53-61. doi: 10.1016/j.puhe.2018.01.007. Epub 2018 Mar 20.

The '6W' multidimensional model of care trajectories for patients with chronic ambulatory care sensitive conditions and hospital readmissions.

Author information

1
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada. Electronic address: Alain.Vanasse@Usherbrooke.ca.
2
Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada. Electronic address: mireille.courteau@Usherbrooke.ca.
3
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC J1H 5N4, Canada; INSERM UMR 1138 Team 22 Centre de Recherche des Cordeliers, Faculté de Médecine, Université Paris Descartes - 15, Rue de L'école de Médecine, 75006 Paris, France. Electronic address: ethierj@gmail.com.

Abstract

OBJECTIVES:

To synthesize concepts and approaches related to the analysis of patterns or processes of care and patient's outcomes into a comprehensive model of care trajectories, focusing on hospital readmissions for patients with chronic ambulatory care sensitive conditions (ACSCs).

STUDY DESIGN:

Narrative literature review.

METHODS:

Published studies between January 2000 and November 2017, using the concepts of 'continuity', 'pathway', 'episode', and 'trajectory', and focused on readmissions and chronic ACSCs, were collected in electronic databases. Qualitative content analysis was performed with emphasis on key constituents to build a comprehensive model.

RESULTS:

Specific common constituents are shared by the concepts reviewed: they focus on the patient, aim to measure and improve outcomes, follow specific periods of time and consider other factors related to care providers, care units, care settings, and treatments. Using these common denominators, the comprehensive '6W' multidimensional model of care trajectories was created. Considering patients' attributes and their chronic ACSCs illness course ('who' and 'why' dimensions), this model reflects their patterns of health care use across care providers ('which'), care units ('where'), and treatments ('what'), at specific periods of time ('when').

CONCLUSIONS:

The '6W' model of care trajectories could provide valuable information on 'missed opportunities' to reduce readmission rates and improve quality of both ambulatory and inpatient care.

KEYWORDS:

Ambulatory care sensitive condition; Care trajectory; Health services research; Patient readmission

PMID:
29499400
DOI:
10.1016/j.puhe.2018.01.007
[Indexed for MEDLINE]
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