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

Malebranche, Mary; Grazioli, Véronique S.; Kasztura, Miriam; Hudon, Catherine; Bodenmann, Patrick

doi:10.1007/s43678-020-00024-4

Cited by 14 publications

(16 citation statements)

References 13 publications

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“…These findings have provided a call for conducting more qualitative research on FUED’s experience of CM in other countries. 13 Considering the important differences in healthcare systems across countries worldwide, it is important to explore how the abovementioned findings are transferable outside of North America. Switzerland’s healthcare system differs from US and Canada’s in that it provides insureds universal coverage based on compulsory health insurance.…”

Section: Introductionmentioning

confidence: 99%

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study

Schaad¹,

Graells²,

Kasztura³

et al. 2023

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Background: Effective management of frequent users of emergency departments (FUED) remains challenging. Case management (CM) has shown to improve patient quality of life while reducing ED visits and associated costs. However, little data is available on FUED’s perception of CM outside of North America to further improve CM implementation. Objectives: Explore the FUED’s perspectives about CM in Switzerland. Design, Setting & Participants: Semi-structured qualitative interviews eliciting FUED’s experiences of CM were conducted among 20 participants (75% female; mean age = 40.6, SD = 12.8) across 6 hospital ED. Outcomes measures & Analysis: Inductive content analysis. Main Results: Most participants were satisfied with the CM program. In particular, FUEDs identified the working relationship with the case manager (cm) as key for positive outcomes, and also valued the holistic evaluation of their needs and resources. Overall, patients reported increased motivation and health literacy, as well as facilitated interactions within the healthcare system. Conversely, a small number of participants reported negative views on CM ( ie, stigmatization, lack of concrete outcomes). Barriers identified were cm’s lack of time, COVID-19′s negative impact on CM organization, as well as lack of clarity on the objectives of CM. FUED perceived CM as useful, in particular establishing a working relationship with the cm. Our results suggest that CM can be further improved by (1) professionals remaining non-judgmental toward FUED, (2) making sure the aims and objectives of the CM are understood by the participants, and (3) allowing more time for the cm to carry out their work.

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Section: Introductionmentioning

confidence: 99%

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study

Schaad¹,

Graells²,

Kasztura³

et al. 2023

INQUIRY

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“…Additional implementation studies conducted in differing contexts or healthcare systems would be useful to confirm and further enrich the findings. In this regard, Malebranche et al recently suggested that further research was needed to better understand the advantages and disadvantages of implementing case management as primary care program versus predominantly ED or hospital-based one [42]. Teper et al's systematic review of CMP implementation in primary care settings identified common facilitators and barriers of CMP implementation in hospital settings including case managers' skills, training, and relationship building and team communication practices [43].…”

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confidence: 99%

Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis

Hudon¹,

Chouinard²,

Bisson³

et al. 2022

International Journal of Integrated Care

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Introduction: Case management programs (CMP) for frequent users of healthcare services presenting complex healthcare needs constitute an effective strategy to improve patient experience of integrated care and to decrease healthcare overuse and cost. This study sought to identify characteristics of these programs, and their implementation contexts, that help to improve patient self-management, experience of integrated care, and healthcare services use. Methods:A mixed methods multiple embedded case study design was conducted, with six CMP implemented in six hospitals of a region of Quebec (Canada).Results: Within-case analysis describes the structural, environmental, organizational, practitioner, patient, and innovation level characteristics of each CMP and their services integration outcomes based on patient experience, self-management and healthcare services use. Cross-case analysis suggests that the skills, leadership and experience of the case manager, providers' access to the individualized services plan, consideration of the needs of the patient and family members, their participation in decision-making, and the self-management approach, impact integrated care and healthcare services use. Conclusion and discussion:This study underscores the necessity of an experienced, knowledgeable and well-trained case manager with interpersonal skills to optimize CMP implementation such that patients are more proactive in their care and their outcomes improve.

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“…Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) have been a focus of attention in emergency medicine for more than 3 decades in developed countries. 1 , 2 Although they represent a small number of patients, they account for a disproportionately high number of all ED visits 3 and are therefore often considered contributors to ED overcrowding. 1 In Switzerland, a study conducted at the Lausanne University Hospital showed that FUED represented 4.4% of all ED patients, accounting for 12.1% of all ED visits.…”

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confidence: 99%

“…In response, previous research focused on identifying, developing, and testing interventions tailored to FUED highlighted case management (CM) as one of the most promising approaches. 2 Consistent with FUED needs, CM is a collaborative intervention that aims to ensure and coordinate tailored care and services on the basis of a holistic evaluation of patients’ needs and priorities. 11 , 12 A growing body of research supports CM effectiveness in reducing ED use and related costs while improving housing and environmental quality of life among FUED.…”

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confidence: 99%

“…To help address this gap between the evidence of CM effectiveness and its use in practice, research providing insight into potential strategies to implement CM is needed. 2 To contribute to this research agenda, our team is currently conducting a project aimed at implementing CM tailored to FUED in public hospitals within the ED in the French speaking part of Switzerland. 15 The first step of this ongoing study was to explore ED staffs’ perceptions of FUED and gauge their interests in implementing CM.…”

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confidence: 99%

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Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

Bodenmann

Kasztura

Graells

et al. 2021

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Frequent users of emergency departments (FUED; ≥ 5 ED visits/year) commonly cumulate medical, social, and substance use problems requiring complex and sustained care coordination often unavailable in ED. This study aimed to explore ED healthcare providers’ challenges related to FUED care to gain insight into the support and resources required to address FUED complex needs. An online survey was sent to all general adult emergency services within Switzerland (N = 106). Participants were asked to indicate the extent to which they perceived that FUED represented a problem and to describe the main challenges encountered. In total, 208 physicians and nurses from 75 EDs (70.7%) completed the survey. Among the 208 participants, 134 (64%) reported that FUED represented a challenge and 133 described 1 to 5 challenges encountered. A conventional content analysis yielded 4 main categories of perceived challenges. Negative consequences in the ED secondary to FUED’s presence (eg, ED overcrowding, staff helplessness, and fatigue) was the most frequently reported challenge, followed by challenges related to FUEDs’ characteristics (eg, mental health and social problems) leading to healthcare complexity. The third most frequently encountered challenge was related to the ED inappropriateness and inefficiency to address FUEDs’ needs. Finally, challenges related to the lack of FUED healthcare network were the least often mentioned. ED healthcare providers experience a wide range of challenges related to FUED care. These findings suggest that currently EDs nor their staff are equipped to address FUEDs’ complex needs.

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

Cited by 14 publications

References 13 publications

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study

Perspectives of Frequent Users of Emergency Departments on a Case Management Intervention: A Qualitative Study

Case Management Programs for Improving Integrated Care for Frequent Users of Healthcare Services: An Implementation Analysis

Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study

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