A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors

Reinius, Peter; Johansson, Magnus; Fjellner, Ann; Werr, Joachim; Öhlén, Gunnar; Edgren, Gustaf

doi:10.1097/mej.0b013e328358bf5a

Cited by 57 publications

(144 citation statements)

References 17 publications

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“…This suggests that CM services may not appeal to some frequent users, who may benefit from alternative outreach strategies. However, this enrollment rate is comparable to those of other studies, 13 and we recruited an adequate number of participants based on power calculations. Although we anticipated a dropout rate of 30 %, we retained 78 % of study participants.…”

Section: Discussionsupporting

confidence: 58%

“…15,34 The non-significant reduction in ED use found in this study underscores the mixed evidence in the literature. At least seven prior studies 12,13,[35][36][37][38][39] showed ED use reductions following a CM or similar intervention, while five studies 9,11,14,40,41 did not. In terms of study design, sample size and intervention (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Two RCTs conducted in Sweden used a lower threshold to define ED frequent use (>3 visits), and implemented interventions different from ours. 13,14 Differences in the definition of frequent use and in intervention design and setting may have contributed to these varying results. Our results may have been influenced by the fact that despite our use of a validated definition, 1 most participants had only 5-6 visits at enrollment, and CM may be of greater benefit for those with higher baseline ED use, given the increased vulnerability of this group.…”

Section: Discussionmentioning

confidence: 99%

“…7,19 Finally, the Hawthorne effect-that people have a tendency to change their behavior when under observation-may have influenced ED use among these participants. In the Reinius study, 13 control participants were passively observed in a Zelen's design, adopted in part to avoid a Hawthorne effect.…”

Section: Discussionmentioning

confidence: 99%

“…three randomized controlled trials (RCTs) have examined the impact of CM on ED use. [11][12][13] Two RCTs 12,13 found that CM reduced the number of ED visits among frequent users, while the third 11 found no significant impact. A randomized informationsharing intervention did not result in a significant reduction in ED use.…”

Section: Trial Registration Clinicaltrialsgov Identifier: Nct01934322mentioning

confidence: 99%

See 4 more Smart Citations

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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 58%