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Published in: Journal of General Internal Medicine 5/2017

01-05-2017 | Original Research

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial

Authors: Patrick Bodenmann, MD, MSc, Venetia-Sofia Velonaki, PhD, Judith L. Griffin, MD, Stéphanie Baggio, PhD, Katia Iglesias, PhD, Karine Moschetti, PhD, Ornella Ruggeri, Psych D, Bernard Burnand, MD MPH, Jean-Blaise Wasserfallen, MD MPP, Francis Vu, MD, Joelle Schupbach, RN, Olivier Hugli, MD MPH, Jean-Bernard Daeppen, MD

Published in: Journal of General Internal Medicine | Issue 5/2017

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Abstract

Background

Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system.

Objective

To determine whether a CM intervention—compared to standard emergency care—reduces ED attendance.

Design

Randomized controlled trial.

Participants

Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months.

Interventions

An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months.

Main Measures

We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective.

Key Results

At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = −0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048).

Conclusions

CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.
Appendix
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Literature
2.
go back to reference van Tiel S, Rood PP, Bertoli-Avella AM, et al. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art. Eur J Emerg Med. 2015. van Tiel S, Rood PP, Bertoli-Avella AM, et al. Systematic review of frequent users of emergency departments in non-US hospitals: state of the art. Eur J Emerg Med. 2015.
3.
go back to reference Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–136.e121.PubMedCrossRef Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126–136.e121.PubMedCrossRef
4.
go back to reference Pines JM, Asplin BR, Kaji AH, et al. Frequent users of emergency department services: gaps in knowledge and a proposed research agenda. Acad Emerg Med. 2011;18(6):e64–e69.PubMedCrossRef Pines JM, Asplin BR, Kaji AH, et al. Frequent users of emergency department services: gaps in knowledge and a proposed research agenda. Acad Emerg Med. 2011;18(6):e64–e69.PubMedCrossRef
5.
go back to reference Vu F, Daeppen J-B, Hugli O, et al. Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emerg Med. 2015;15(1):27.PubMedPubMedCentralCrossRef Vu F, Daeppen J-B, Hugli O, et al. Screening of mental health and substance users in frequent users of a general Swiss emergency department. BMC Emerg Med. 2015;15(1):27.PubMedPubMedCentralCrossRef
7.
go back to reference Althaus F, Paroz S, Hugli O, et al. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med. 2011;58(1):41–52.e42.PubMedCrossRef Althaus F, Paroz S, Hugli O, et al. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med. 2011;58(1):41–52.e42.PubMedCrossRef
8.
go back to reference Kumar GS, Klein R. Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review. J Emerg Med. 2013;44(3):717–729.PubMedCrossRef Kumar GS, Klein R. Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review. J Emerg Med. 2013;44(3):717–729.PubMedCrossRef
9.
go back to reference Lee K-H, Davenport L. Can case management interventions reduce the number of emergency department visits by frequent users? Health Care Manag. 2006;25(2):155–159. Lee K-H, Davenport L. Can case management interventions reduce the number of emergency department visits by frequent users? Health Care Manag. 2006;25(2):155–159.
11.
go back to reference Spillane LL, Lumb EW, Cobaugh DJ, Wilcox SR, Clark JS, Schneider SM. Frequent users of the emergency department: can we intervene? Acad Emerg Med. 1997;4(6):574–580.PubMedCrossRef Spillane LL, Lumb EW, Cobaugh DJ, Wilcox SR, Clark JS, Schneider SM. Frequent users of the emergency department: can we intervene? Acad Emerg Med. 1997;4(6):574–580.PubMedCrossRef
12.
go back to reference Shumway M, Boccellari A, O’Brien K, Okin RL. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial⋆. Am J Emerg Med. 2008;26(2):155–164.PubMedCrossRef Shumway M, Boccellari A, O’Brien K, Okin RL. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial⋆. Am J Emerg Med. 2008;26(2):155–164.PubMedCrossRef
13.
go back to reference Reinius P, Johansson M, Fjellner A, Werr J, Öhlén G, Edgren G. A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors. Eur J Emerg Med. 2013;20(5):327–334.PubMedCrossRef Reinius P, Johansson M, Fjellner A, Werr J, Öhlén G, Edgren G. A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors. Eur J Emerg Med. 2013;20(5):327–334.PubMedCrossRef
14.
go back to reference Hansagi H, Olsson M, Hussain A, Öhlén G. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users? Eur J Emerg Med. 2008;15(1):34–39.PubMedCrossRef Hansagi H, Olsson M, Hussain A, Öhlén G. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users? Eur J Emerg Med. 2008;15(1):34–39.PubMedCrossRef
15.
go back to reference LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42–48.PubMedCrossRef LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42–48.PubMedCrossRef
16.
go back to reference Bieler G, Paroz S, Faouzi M, et al. Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Acad Emerg Med. 2012;19(1):63–68.PubMedCrossRef Bieler G, Paroz S, Faouzi M, et al. Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Acad Emerg Med. 2012;19(1):63–68.PubMedCrossRef
18.
go back to reference Leu RE RF, Brouwer W, Matter P, Rütschi C. The swiss and dutch health insurance systems: Universal coverage and regulated competitive insurance markets. Website of the Commonwealth Fund: Commonwealth Fund 2009. Leu RE RF, Brouwer W, Matter P, Rütschi C. The swiss and dutch health insurance systems: Universal coverage and regulated competitive insurance markets. Website of the Commonwealth Fund: Commonwealth Fund 2009.
19.
go back to reference Bodenmann P, Velonaki V-S, Ruggeri O, et al. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res. 2014;14(1):264.PubMedPubMedCentralCrossRef Bodenmann P, Velonaki V-S, Ruggeri O, et al. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res. 2014;14(1):264.PubMedPubMedCentralCrossRef
20.
go back to reference Sanchez B, Hirzel AH, Bingisser R, et al. State of emergency medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6(1):1–11.CrossRef Sanchez B, Hirzel AH, Bingisser R, et al. State of emergency medicine in Switzerland: a national profile of emergency departments in 2006. Int J Emerg Med. 2013;6(1):1–11.CrossRef
22.
go back to reference Bodenmann P, Baggio S, Iglesias K, et al. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health. 2015;14(1):146.PubMedPubMedCentralCrossRef Bodenmann P, Baggio S, Iglesias K, et al. Characterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study. Int J Equity Health. 2015;14(1):146.PubMedPubMedCentralCrossRef
23.
go back to reference Canepa Allen MCAC, Schüpbach J, Vu F, Bouche L, Ninane F, Bodenmann P. Respectful nursing support of patient priorities. Krankenpfl Soins Infirm. 2014;107(6):62–65. Canepa Allen MCAC, Schüpbach J, Vu F, Bouche L, Ninane F, Bodenmann P. Respectful nursing support of patient priorities. Krankenpfl Soins Infirm. 2014;107(6):62–65.
24.
go back to reference Baggio S, Iglesias K, Hugli O, et al. Associations between perceived discrimination and health status among frequent Emergency Department users. Eur J Emerg Med. 2015. Baggio S, Iglesias K, Hugli O, et al. Associations between perceived discrimination and health status among frequent Emergency Department users. Eur J Emerg Med. 2015.
25.
26.
go back to reference Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med. 2003;56(6):1321–1333.PubMedCrossRef Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med. 2003;56(6):1321–1333.PubMedCrossRef
27.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.PubMedCrossRef
28.
go back to reference Spitzer RL, Kroenke K, Williams JB, PHQPCS Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737–1744.PubMedCrossRef Spitzer RL, Kroenke K, Williams JB, PHQPCS Group. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737–1744.PubMedCrossRef
29.
go back to reference Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.PubMed Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59:22–33.PubMed
30.
go back to reference World Health Organization ASSIST Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–1194.CrossRef World Health Organization ASSIST Working Group. The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–1194.CrossRef
31.
go back to reference Moore G, Gerdtz M, Manias E, Hepworth G, Dent A. Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery. BMC Public Health. 2007;7(1):320.PubMedPubMedCentralCrossRef Moore G, Gerdtz M, Manias E, Hepworth G, Dent A. Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery. BMC Public Health. 2007;7(1):320.PubMedPubMedCentralCrossRef
32.
go back to reference Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med. 2006;48(1):16. e11–16. e18.CrossRef Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med. 2006;48(1):16. e11–16. e18.CrossRef
33.
go back to reference Dent AW, Phillips GA, Chenhall AJ, McGregor LR. The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med. 2003;15(4):322–329.CrossRef Dent AW, Phillips GA, Chenhall AJ, McGregor LR. The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg Med. 2003;15(4):322–329.CrossRef
34.
go back to reference National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables. CDC;2011. National Hospital Ambulatory Medical Care Survey: 2011 Emergency Department Summary Tables. CDC;2011.
35.
go back to reference Wassmer R, Winward L, Derlet R. Does counseling reduce frequent emergency department use? 2008. Wassmer R, Winward L, Derlet R. Does counseling reduce frequent emergency department use? 2008.
36.
go back to reference Okin R, Boccellari A, Azocar F, et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18(5):603–608.PubMedCrossRef Okin R, Boccellari A, Azocar F, et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18(5):603–608.PubMedCrossRef
37.
go back to reference Pope D, Fernandes C, Bouthillette F, Etherington J. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017–1020.PubMedPubMedCentral Pope D, Fernandes C, Bouthillette F, Etherington J. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017–1020.PubMedPubMedCentral
38.
go back to reference Grover CA, Close RJH, Villarreal K, Goldman LM. Emergency department frequent user: pilot study of intensive case management to reduce visits and computed tomography. West J Emerg Med. 2010;11(4):336–343.PubMedPubMedCentral Grover CA, Close RJH, Villarreal K, Goldman LM. Emergency department frequent user: pilot study of intensive case management to reduce visits and computed tomography. West J Emerg Med. 2010;11(4):336–343.PubMedPubMedCentral
39.
go back to reference Skinner J, Carter L, Haxton C. Case management of patients who frequently present to a Scottish emergency department. Emerg Med J. 2009;26(2):103–105.PubMedCrossRef Skinner J, Carter L, Haxton C. Case management of patients who frequently present to a Scottish emergency department. Emerg Med J. 2009;26(2):103–105.PubMedCrossRef
40.
go back to reference Wexler R, Hefner JL, Sieck C, et al. Connecting emergency department patients to primary care. J Am Board Fam Med. 2015;28(6):722–732.PubMedCrossRef Wexler R, Hefner JL, Sieck C, et al. Connecting emergency department patients to primary care. J Am Board Fam Med. 2015;28(6):722–732.PubMedCrossRef
41.
go back to reference Phillips G, Brophy D, Weiland T, Chenhall A, Dent A. The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Med J Aust. 2006;184(12):602–606.PubMed Phillips G, Brophy D, Weiland T, Chenhall A, Dent A. The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Med J Aust. 2006;184(12):602–606.PubMed
42.
go back to reference Doupe MB, Palatnick W, Day S, et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med. 2012;60(1):24–32.PubMedCrossRef Doupe MB, Palatnick W, Day S, et al. Frequent users of emergency departments: developing standard definitions and defining prominent risk factors. Ann Emerg Med. 2012;60(1):24–32.PubMedCrossRef
43.
go back to reference World Health Organization. The World Health Report 2008: primary health care (now more than ever). 2014. World Health Organization. The World Health Report 2008: primary health care (now more than ever). 2014.
44.
go back to reference Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.PubMedCrossRef Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.PubMedCrossRef
45.
go back to reference Althaus F, Stucki S, Guyot S, et al. Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series. Eur J Emerg Med. 2013;20(6):413–419.PubMedCrossRef Althaus F, Stucki S, Guyot S, et al. Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series. Eur J Emerg Med. 2013;20(6):413–419.PubMedCrossRef
Metadata
Title
Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial
Authors
Patrick Bodenmann, MD, MSc
Venetia-Sofia Velonaki, PhD
Judith L. Griffin, MD
Stéphanie Baggio, PhD
Katia Iglesias, PhD
Karine Moschetti, PhD
Ornella Ruggeri, Psych D
Bernard Burnand, MD MPH
Jean-Blaise Wasserfallen, MD MPP
Francis Vu, MD
Joelle Schupbach, RN
Olivier Hugli, MD MPH
Jean-Bernard Daeppen, MD
Publication date
01-05-2017
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 5/2017
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-016-3789-9

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