The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study

Grover, Casey A.; Crawford, Elizabeth; Close, Reb J.H.

doi:10.1016/j.jemermed.2016.06.002

Cited by 22 publications

(42 citation statements)

References 24 publications

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“…The various implemented provisions that have proven to be effective so far focused on a subgroup of FEDU with specific characteristics, but these were site and area specific, which might not be applicable to other settings . In particular, case management is the most dominant of those and reduced the number of ED visits of FEDU, but in some cases failed to deal with substance abuse, addiction and psychiatric problems, and chronic pain–related ED visit . As our findings indicate, these reasons are among the most prevalent drivers for seeking frequent ED care.…”

Section: Discussionsupporting

confidence: 61%

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Giannouchos

Kum

Foster

et al. 2019

Evaluation Clinical Practice

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Study objective:We conducted a systematic literature review to identify and to update patient characteristics and contextual factors for adult frequent emergency department users (FEDUs) compared with non-FEDU in an era where the US health care system underwent substantial changes. Methods:We searched MEDLINE, CINAHL, and EMBASE to identify all relevant articles after 2010 through July 2018 that describe FEDU. We included US studies on adult FEDU only and excluded studies on specific subgroups of FEDU. We included demographic, clinical, and health care utilization information, and two reviewers independently evaluated the studies using the Joanna Briggs Institute Critical Appraisal tool. Results:The 11 studies included in the review indicated that FEDU were 4% to 16% of total ED users but accounted for 14% to 47% of ED visits, with six to nine visits per year on average. The majority of FEDU were young or middle-aged adults, females, of low socioeconomic status and high school or less education, with public insurance, multiple primary care provider visits, and chronic conditions. Fair or poor self-perceived health status, unemployment, unmet needs from primary care providers (PCPs), mental health, and substance abuse were predictors of FEDU. Conclusion:FEDUs are disproportionally sicker and are also heavy users of non-ED health care service providers. The limited data for non-ED health services use in facility-specific studies of FEDU may contribute to findings in such studies that complex and unmet needs from PCPs contributed to ED visits. This suggests the need for more comprehensive data analysis beyond a few sites that can inform systemic management approaches.

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Section: Discussionsupporting

confidence: 61%

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Giannouchos

Kum

Foster

et al. 2019

Evaluation Clinical Practice

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“…Rinke et al 35 in a study evaluating the impact of the implementation of a care plan by a case manager for the most frequent emergency medical services (EMS) users, as well as Tadros et al , 36 in a study evaluating a CM intervention conducted by a case manager among frequent EMS users, observed a decrease in EMS cost and use. Finally, Grover et al 38 evaluated the effectiveness of a multidisciplinary CM intervention including a care plan among frequent ED users and reported a reduction in ED use and radiation exposure, improved efficacy of referral, but no change in number of admissions.…”

Section: Resultsmentioning

confidence: 99%

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

et al. 2017

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ObjectiveThe aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness.DesignThematic analysis review of CM studies.MethodsWe built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004–December 2015 period, then updated to July 2017, with the keywords ‘CM’ and ‘frequent use’. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir’s implementation of health innovations framework was used to organise results into four broad levels of factors: (1) environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level.ResultsAccess to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration.ConclusionsCM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts.

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“…A number of interventions aimed at reducing the number of ED visits by frequent users have been evaluated in the literature; some of them were case management, individualized care plan and information sharing (18). Case management, which is a comprehensive, interdisciplinary approach taken to assess, plan, personalize, and guide an individual's health services to promote improved patient and health system outcomes, seems effective to reduce ED usage of frequent users and improve both clinical and social outcomes among them (19)(20)(21). Individualised care plans were similar to case management but less comprehensive that, they employ interdisciplinary strategies and coordinated access to primary care resources (18).…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analyses of Frequent Emergency Department Users

Işık¹,

Tandoğan²,

Şafak³

et al. 2020

Eurasian J Emerg Med

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Aim: Emergency department (ED) demand and overcrowding is increasing worldwide, and a significant portion of this overcrowding is caused by ''frequent users''. The aim of the study is to define the characteristics of this group of patients who contribute towards a disproportionate number of ED visits. Materials and Methods: All ED visits during a 1-year period between 01 January 2018 and 31 December 2018 were retrospectively investigated using the electronic registration system of the hospital. Patients who visited the ED ≥4 times in this period were considered as ''frequent users''. Social history, disease and care-related factors of frequent users were investigated. Results: A total of 335,457 ED visits made in a calendar year (2018) were investigated. Frequents users comprised 6.8% of all ED patient population and 22.9% of all ED visits. Female gender proportion was greater among frequent users, and frequent users were younger than occasional users. Yellow/red triage code ratio was higher and the median length of hospital stay was significantly longer in the frequent users group. The proportion of uninsured patients was two times higher in the frequent users group, and half of these patients were immigrants or refugees. Conclusion: Frequent users place a significant burden on the increasing patient volume in EDs. Welfare status was an important indicator for being a frequent user. However, frequent users are a very heterogeneous patient group and more research is needed to better understand the factors leading to frequent ED use and to develop effective strategies to meet patients' complex health care needs.

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The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study

Cited by 22 publications

References 24 publications

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Characteristics and predictors of adult frequent emergency department users in the United States: A systematic literature review

Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

Retrospective Analyses of Frequent Emergency Department Users

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