Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial.

Details

Serval ID
serval:BIB_FE79B0F09E8E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial.
Journal
Journal of general internal medicine
Author(s)
Bodenmann P., Velonaki V.S., Griffin J.L., Baggio S., Iglesias K., Moschetti K., Ruggeri O., Burnand B., Wasserfallen J.B., Vu F., Schupbach J., Hugli O., Daeppen J.B.
ISSN
1525-1497 (Electronic)
ISSN-L
0884-8734
Publication state
Published
Issued date
05/2017
Peer-reviewed
Oui
Volume
32
Number
5
Pages
508-515
Language
english
Notes
Publication types: Journal Article ; Pragmatic Clinical Trial ; Randomized Controlled Trial
Publication Status: ppublish
Abstract
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.
To determine whether a CM intervention-compared to standard emergency care-reduces ED attendance.
Randomized controlled trial.
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.
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.
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.
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).
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.

Keywords
Adult, Aged, Case Management/trends, Emergency Service, Hospital/trends, Emergency Service, Hospital/utilization, Female, Follow-Up Studies, Hospitals, University/trends, Humans, Male, Middle Aged, National Health Programs/trends, Patient Acceptance of Health Care, Single-Blind Method, Switzerland/epidemiology, case management, clinical trials, utilization, vulnerable populations
Pubmed
Web of science
Open Access
Yes
Create date
13/02/2017 16:01
Last modification date
20/08/2019 17:29
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