BMJ open · 2026
Establishing criteria for emergency department-based episode of care definitions: a modified Delphi study.
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Kocher Keith E, Myers Aimee D, Urech Tracy H, Asch Steven, Admon Andrew, Fuehrlein Brian S, Gettel Cameron J, Patel Neil, Pines Jesse M, Potochny Nicholas S, Sabbatini Amber K, Vanneman Megan, Ward Michael J, Vashi Anita
Аннотация
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.
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.