Care plan program reduces the number of visits for challenging psychiatric patients in the ED

Abello, A.; Brieger, B.; Dear, K; King, Ben; Ziebell, Christopher; Ahmed, Atheer; Milling, Truman J.

doi:10.1016/j.ajem.2011.07.002

Cited by 22 publications

(29 citation statements)

References 25 publications

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“…The risk of bias of NCBA studies ranged from high (n = 7) 14,30,[32][33][34]37,40 to moderate (n = 14). 12,13,15,16,[25][26][27][28][29]31,35,36,38,39 Quality issues related to the study participants' representativeness, enrollment of all eligible participants into the study, adequate sample size, outcome assessor blinding, and lack of multiple outcome measurements were identified. No included studies had a low risk of bias.…”

Section: Methodologic Quality Of the Studiesmentioning

confidence: 99%

“…One study 27 arranged social work home visits to identify patient needs. All but seven studies 25,30,31,34,43,48,49 explicitly defined frequent ED use and followed ED visits at a single institution rather than at multiple centers.…”

Section: Characteristics Of Interventionsmentioning

confidence: 99%

“…12,13,15,25,27,31,32,34,36,37,[39][40][41]45,46,48,49 Other countries represented were Canada, 38,43 the United Kingdom, 16,26,33 Australia, 14,30 Sweden, 17,28,44,47 Scotland, 35 Taiwan, 29 and Switzerland. 42 Overall, studies included a general frequent user population; however, some focused their inclusion on subgroups with psychiatric, mental health or substance abuse comorbidities, 25,26,36,39,43 homeless, low income, unemployed or uninsured/underinsured patients, 13 41 Additional definitions were more than three visits in 6 months, 44 10 visits in 6 months, 35 three visits in 1 month, 37 and three or more visits in 72 hours. 29 Other studies considered the top 30, 33 50, 15 or 100 attendees 36 to be frequent users or allowed staff or investigators to determine inclusion without specified thresholds …”

Section: Study Characteristicsmentioning

confidence: 99%

“…Twenty-one NCBA studies, [12][13][14][15][16][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] six RCTs, 17,[41][42][43][44][45] and four CBA studies [46][47][48][49] examined interventions targeting adult frequent ED users. The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The studies were published between 1985 and 2014 (median publication year = 2010; IQR = 2006 to 2013). Most (n = 23) were published in peer-reviewed journals, [12][13][14][15][16][17][25][26][27][28][29][30][35][36][37][38][39]41,[44][45][46][47][48][49] five were scientific conference abstracts, [31][32][33][34]40 and two were protocols for planned RCTs. 42,43 Authors of primary studies were mainly from the United States.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 4 more Smart Citations

Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review

Moe

Kirkland

Rawe

et al. 2017

Academic Emergency Medicine

169

138

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Objectives: Frequent emergency department (ED) users are high-risk and high-resource-utilizing patients. This systematic review evaluates effectiveness of interventions targeting adult frequent ED users in reducing visit frequency and improving patient outcomes.Methods: An a priori protocol was published in PROSPERO. Two independent reviewers screened, selected, rated quality, and extracted data. Third-party adjudication resolved disagreements. Rate ratios of post-versus pre-intervention ED visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users' ED visits and patient-oriented outcomes.Results: A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (n = 21) and controlled (n = 4) before-after studies and randomized controlled trials (n = 6). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (n = 18), care plans (n = 8), diversion strategies (n = 3), printout case notes (n = 1), and social work visits (n = 1). Post-versus pre-intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range = 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease ED visits post-intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6-or 12-month follow-up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high. The authors have no potential conflicts to disclose. PROSPERO registration number CRD42014015058. Study group authorship: Jessica Moe conceptualized and drafted the protocol, screened abstracts and articles for inclusion, extracted data, analyzed data, and wrote the manuscript; Scott Kirkland helped to draft the protocol, screened abstracts and articles for inclusion, analyzed data, assessed study quality, and wrote sections of the manuscript; Erin Rawe drafted the protocol and extracted data; Maria Ospina helped to draft the protocol, assessed study quality, and provided third-party adjudication for inclusion screening and quality assessment; Ben Vandermeer helped to plan and perform the statistical analysis; Sandy Campbell developed and ran the search strategy; Brian H. Rowe conceptualized the protocol, provided third-party adjudication for inclusion screening and quality assessment, analyzed data, and wrote a section of the manuscript. All authors reviewed, edited, and approved the final manuscript. Existing evide...

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