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A sequential model for the structure of health care utilization.

Herrmann, W.J., Haarmann, A., Baerheim, A. A sequential model for the structure of health care utilization. PLoS One: 2017, 12(5), e0176657
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Traditional measurement models of health care utilization are not able to represent the complex structure of health care utilization. In this qualitative study, we, therefore, developed a
new model to represent the health care utilization structure. In Norway and Germany, we
conducted episodic interviews, participant observation and a concurrent context analysis.
Data was analyzed by thematic coding in the framework of grounded theory. Consultations
do very often not only have one single reason for encounter. They are usually not independent
events but form part of consultation sequences. We could find structural differences
between Norway and Germany regarding the flow of information between consultations and
which providers are involved in health care in what way. This leads to a sequential model, in
which health care utilization is seen as sequences of consultations. Such health care utilization
sequences consist of nodes which are connected by edges. Nodes represent patientprovider
contacts and edges depict the flow of information. Time and the level of health care
providers are dimensions in the model. These sequences can be described by different
measures and aggregated on population level. Thus, the sequential model can be further
used in analyzing health care utilization quantitatively, e.g., by using routine data. (aut. ref.)