The effects of clinical case management on hospital service use among ED frequent users

Okin, Robert L.; Boccellari, Alicia; Azocar, Francisca; Shumway, Martha; OʼBrien, Kathy; Gelb, Alan; Kohn, Michael A.; Harding, Phyllis; Wachsmuth, Christine

doi:10.1053/ajem.2000.9292

Cited by 176 publications

(287 citation statements)

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“…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%

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: Discussionmentioning

confidence: 99%

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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“…The review built on an existing evidence synthesis, prepared by the VA's EvidenceBased Synthesis Program Coordinating Center. 11 Researchers 14,16,18,[21][22][23][30][31][32][33] and with review articles describing healthcare delivery interventions for patients with complex chronic illnesses. [34][35][36] The review incorporated key findings, study design, and implementation strategies, 37 and was discussed with facility leadership to identify common elements of successful programs that would be viable and effective within the VA environment and at the local facility.…”

Section: Methodsmentioning

confidence: 99%

“…30 Lessler and colleagues 32 provide additional information on King County Care Partners. 18 Okin and colleagues 33 provide additional information on the program described by Shumway and colleagues 16 the facility, and were made available to ImPACT patients via referral.…”

Section: Characterization Of Target Patient Populationmentioning

confidence: 99%

Partnered Research in Healthcare Delivery Redesign for High-Need, High-Cost Patients: Development and Feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT)

et al. 2014

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“…In addition to its inpatient services, the department operates the city's psychiatric emergency service, eight assertive community treatment programs, and other individual intensive case management services for thousands of patients at risk of psychiatric hospitalization, as well as for repeated users of inpatient treatment, high users of the criminal justice system, and high users of the medical emergency room (Okin et al 2000). The department also operates a Trauma Recovery Center for victims of violence who are showing symptoms of emotional problems (Boccellari et al 2007).…”

Section: The San Francisco Mental Health Systemmentioning

confidence: 99%

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

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Segal

Mezzina³

et al. 2015

Cult Med Psychiatry

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According to the World Health Organization (WHO), the ''Trieste model'' of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person-not his or her disorders-at the center of the health care system. The model, revolutionary in its time, began with the ''negation'' and ''destruction'' of the traditional mental asylum ('manicomio'). A novel community mental health system replaced the mental institution. To achieve this, the Trieste model promoted the social inclusion and full citizenship of users of mental health services. Trieste has been a collaborating center of the WHO for four decades with a goal of disseminating its practices across the world. This paper illustrates a recent attempt to determine whether the Trieste model could be translated to the city of San Francisco, California. This process revealed a number of obstacles to such a translation. Our hope is that a review of Basaglia's ideas, along with a discussion of the obstacles to their implementation, will facilitate efforts to foster the social integration of persons with mental disorders across the world.

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The effects of clinical case management on hospital service use among ED frequent users

Cited by 176 publications

References 0 publications

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

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

Partnered Research in Healthcare Delivery Redesign for High-Need, High-Cost Patients: Development and Feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT)

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

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