A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial

Edgren, Gustaf; Anderson, Jacqueline; Dolk, Anders; Torgerson, Jarl; Nyberg, Svante; Skau, Tommy; Forsberg, Birger C; Werr, Joachim; Öhlén, Gunnar

doi:10.1097/mej.0000000000000280

Cited by 26 publications

(89 citation statements)

References 16 publications

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“…All of the studies included development and implementation of a care plan, 15 involved an interdisciplinary team, [40][41][42][43][45][46][47][49][50][51]53,[55][56][57][58] and 11 were conducted in an ED setting. 41,43,44,47,[49][50][51][52]55,57,58 For the majority of studies (n = 17), CM intervention participants were identified using a threshold of number of health care visits. [40][41][42][43][44][46][47][48][49][50][52][53][54][55][56][57]59 To determine eligibility, 9 studies required patients be evaluated by a health care provider to assess their likelihood of benefiting from the CM intervention.…”

Section: Resultsmentioning

confidence: 99%

“…41,43,44,47,[49][50][51][52]55,57,58 For the majority of studies (n = 17), CM intervention participants were identified using a threshold of number of health care visits. [40][41][42][43][44][46][47][48][49][50][52][53][54][55][56][57]59 To determine eligibility, 9 studies required patients be evaluated by a health care provider to assess their likelihood of benefiting from the CM intervention. 42,44,[47][48][49]51,52,55,58 Ten studies included patients with a complex/vulnerable situation such as the presence of physical, psychiatric, and/or psychosocial issues.…”

Section: Resultsmentioning

confidence: 99%

“…[40][41][42][43][44][46][47][48][49][50][52][53][54][55][56][57]59 To determine eligibility, 9 studies required patients be evaluated by a health care provider to assess their likelihood of benefiting from the CM intervention. 42,44,[47][48][49]51,52,55,58 Ten studies included patients with a complex/vulnerable situation such as the presence of physical, psychiatric, and/or psychosocial issues. 40,42,43,45,46,48,[51][52][53][54] The methodologic quality of the included studies ranged from 25% to 100% (median, 50%).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies reported positive outcomes such as health and functional status, 52 patient satisfaction, 40,52 selfmanagement, 45,46,47,49,[51][52][53][54][55]58 and clinic visits, 40,44,45,52 hospital admission 42,44,45,53 and length of stay, 42,45,52 and ED 43,44,[52][53][54][55]57,58 and inpatient cost. 43,44,45,[52][53][54] Regarding the conditions, 16 studies implemented a high-intensity CM intervent ion [40][41][42][43][44][45][46]48,49,[51][52][53]…”

Section: Resultsmentioning

confidence: 99%

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Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

et al. 2019

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PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

et al. 2019

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“…[3] Frequent users (FUs usually ≥ 4 visits during 12 months) have been suggested as an important reason for ED crowding. [4] In this article, we identified the characteristics of double frequent users (DFUs), ≥ 8 visits during 12 months and at least 25 visits to ED during a period of six years. The primary outcome was to understanding reasons for frequent visits to the ED.…”

Section: Introductionmentioning

confidence: 99%

Characterising double frequent users in an emergency department

Raidla

Dárro

Carlson

et al. 2018

JHA

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Visits by frequent users (FUs) has been suggested as one reason for crowding in emergency departments (EDs). In this article, we identified the characteristics of double frequent users (DFUs), ≥ 8 visits during 12 months in an ED during a period of six years, in one ED in Western Sweden. The primary outcome was to characterise DFUs and find common reasons for repeatedly visiting the ED. We conducted a retrospective cohort analysis on register data covering six years of all visits. The DFUs share of all visitors to the ED was not more than 0.03% (144 individuals), but their share of visits was 2.4% (1,017 visits/year). Chest pain and abdominal pain were the most common complaints. A typical DFU is male, around 50-year-old, unemployed, non-immigrant, suffering from alcohol abuse and/or mental health conditions. The results point to the need for changing strategies in ED services towards DFUs suffering from alcohol abuse and/or mental health conditions. The ED prioritises the severely ill but lacks resources and continuity for handling chronic diseases and follow-up routines.

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Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials

et al. 2022

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Background For patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization. Objective Examine effect of PRCs on acute care utilization. Design Combined results of 2 parallel 1:1 randomized controlled trials. Participants Inpatient adults with substance use disorder Interventions Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) Main Measures Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores. Key Results A total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = −0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = −2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65). Conclusions PRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use. Trial Registration ClinicalTrials.gov (NCT04098601, NCT04098614) Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07360-w.

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A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial

Abstract: Supplemental Digital Content is available in the text.

Cited by 26 publications

References 16 publications

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review

Characterising double frequent users in an emergency department

Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials

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