Effectiveness of Case Management Strategies in Reducing Emergency Department Visits in Frequent User Patient Populations: A Systematic Review

Kumar, Gayathri S.; Klein, Robin

doi:10.1016/j.jemermed.2012.08.035

Cited by 187 publications

(206 citation statements)

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“…6 Case management (CM) is an intervention designed to assist frequent ED users in reducing their ED utilization. 7,8 CM aims to meet patients' individual needs and to optimize resource allocation for the frequent user and payer. 9,10 To our knowledge, only…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…It is also possible that a 6-month follow-up period is not sufficient to observe a significant change in frequent users' self-management. 6 Considering that 30% of intervention group patients had depression or anxiety symptoms at baseline, it is possible that it took a few months for case management to reduce their anxiety so that they could be receptive to self-management support. Indeed, patients with higher psychological distress could be less receptive to such support.…”

Section: Findings In Contextmentioning

confidence: 99%

“…5 Case management is the intervention most supported by evidence on improving appropriate use of health care resources, decreasing undue costs, and increasing patient well-being in this population. [5][6][7] According to the Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes." 8 Many reviews have documented the positive impacts of case management among frequent users of health care services.…”

Section: Introductionmentioning

confidence: 99%

“…Althaus et al 9 concluded that case management decreased emergency department use and costs, and improved clinical and social outcomes. Reviews by Kumar and Klein 6 and Soril et al 5 also reported that the majority of evidence pointed to the benefits of case management interventions for frequent users. Although findings of Stokes et al 10 did not support case management to reduce health care use and costs for the oldest at-risk patients, they did show improvement in patient satisfaction in the long term.…”

Section: Introductionmentioning

confidence: 99%

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Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

et al. 2018

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PURPOSE This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. METHODSWe used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. RESULTSA total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation (P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health.CONCLUSIONS Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs. Ann Fam Med 2018;16:232-239. https://doi.org/10.1370/afm.2233. INTRODUCTIONF requent use of health care services is often driven by the complex health and social care needs of individuals having chronic physical conditions and, often, mental health comorbidities, sometimes accompanied by social vulnerability.1,2 Frequent users with chronic disease and complex care needs often experience fragmented, uncoordinated, and ineffective health care, resulting in poor health outcomes at considerable costs to the health care system. 3 Although high use may be defined from either a frequency or cost perspective, the former is more convenient and easier to measure when identifying this population in a pragmatic context. Given that primary care is a first point of contact with the health and social care system, it may play a strong role in allowing the implementation of innovations to provide more coordinated care. 4 Different interventions have been developed and evaluated to improve care for frequent users of health care services, such as case management, individualized care plans, self-management support, and information sharing. 5 Case management is the intervention most supported by evidence on improving appropriate use of health care resources, decreasing undue C...

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“…Some beneficial results have been found in studies covering the effectiveness of case management (CM). Kumar & Klein [18] showed, in their literature review, that intensive CM reduced the cost and number of ED visits. The content of such a CM programme involved frequent follow-up of patients, availability of psychosocial services and finance entitlements plus a high level of patient involvement in care planning.…”

Section: Introductionmentioning

confidence: 99%

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

Persson¹

2014

Int J Nurs Clin Pract

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Background: Patients who repeatedly seek care directly at hospital based somatic emergency departments take up a large proportion of health care resources, at the same time they appear to experience low satisfaction with the care they receive. The purposes of this pilot study were to describe: I) the development of a team model for taking care of frequent visitors to a somatic hospital based ED; II) Eventual changes, over six months, in costs and patients' health care utilization related to pilot testing the model and III), the team's experiences of implementing the model. Methods: A mixed method convergent parallel design was used. Results:The development of the model began as a top-down process and later on into a bottom-up approach once the inter-professional team became involved. The new model functioned as a support for all 12 patients included in the study and collectively their visits decreased by a total of 73 visits (55%). Conclusion:The inference quality description is that a management induced project may be accepted and actively applied when those involved experience freedom to structure the project. Increased communication between different professionals within the hospital and between different caregivers such as ED, primary health care and community social-and health-care, increases the possibility for the patients to be cared for in a sustainable and non-fragmented way.

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Effectiveness of Case Management Strategies in Reducing Emergency Department Visits in Frequent User Patient Populations: A Systematic Review

Cited by 187 publications

References 42 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

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study

A New Model for Dealing with Patients Who Frequently Arrive Spontaneously at Hospital Emergency Departments Requiring Health Care: A Pilot Study

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