Elsevier

Public Health

Volume 157, April 2018, Pages 53-61
Public Health

Review Paper
The ‘6W’ multidimensional model of care trajectories for patients with chronic ambulatory care sensitive conditions and hospital readmissions

https://doi.org/10.1016/j.puhe.2018.01.007Get rights and content
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Highlights

  • The ‘6W’ multidimensional model of care trajectories represents the pattern of care use of patients with ACSCs.

  • The ‘who–why–which–where–what–when’ considers patients, illness conditions, care providers, care units, treatments and time.

  • This model integrates concepts of chronic illness, continuity, pathway, episode, transition and trajectory.

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
Patient readmission
Health services research

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