Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol

Abstract

BackgroundED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs’ quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention.MethodsThis research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants’ trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations.DiscussionThis research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications.Trial registrationNCT03641274, Registered 20 August 2018.

Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception

“…The external psychiatrist consultation service in the ED with CM was subject to negative evaluation from nurses in qualitative exploration. An integrated psychiatric unit may provide greater support to staff facing FUED psychiatric and behavioral issues, representing an important part of FUED care [ 17 ]. In addition, qualitative exploration revealed that CM activity was considered not visible enough.…”

“…Email reminders were sent until at least a 60% [ 20 ] participation rate was achieved in both groups. All procedures were approved by the Swiss Ethics Committee (project number 2018–00442) [ 17 ].…”

“…This study was nested in a larger ongoing research project that aimed to develop and implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland (project number 2018–00442) [ 17 ].…”

Health care providers’ perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland

“…There has been a call from health authorities and hospitals in Switzerland for better care of FUEDs via interventions specifically adapted to them, such as the CM [24]. The importance of the FUEDs issue in Switzerland, as reported in various regional surveys [5,[25][26][27] and the scant information on the perceptions of local ED professionals [20] prompted us to conduct a survey at the national level among ED staff (medical doctors and nurses from different linguistic regions and EDs specialization levels) in order to evaluate: a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of CM and interest in implementing this intervention in their ED service.…”

Case management for frequent emergency department users: no longer a question of if but when, where and how

“…Further, two ongoing trials are helping advance the field. First, at the University of Lausanne, a multi-site trial called the I-CaM project (Implementing a Case Management Intervention for Frequent User of the Emergency Department) has been recruiting participants since 2018 [ 12 ]. The trial’s objectives are twofold: (1) to develop and implement a case management intervention tailored to frequent users across multiple EDs, and (2) to evaluate the implementation process and effectiveness.…”