Patrick Bodenmann1, Venetia-Sofia Velonaki2, Judith L Griffin3, Stéphanie Baggio4, Katia Iglesias5,6, Karine Moschetti6,7,8, Ornella Ruggeri9, Bernard Burnand6, Jean-Blaise Wasserfallen7, Francis Vu3, Joelle Schupbach3, Olivier Hugli10, Jean-Bernard Daeppen11. 1. Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. Patrick.Bodenmann@hospvd.ch. 2. Institute of Higher Education and Research in Healthcare, Department of Community Medicine and Public Health, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. 3. Vulnerable Populations Center, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. 4. Life Course and Social Inequality Research Center, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland. 5. Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland. 6. Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland. 7. Technology Assessment Unit, Lausanne University Hospital, Lausanne, Switzerland. 8. IEMS - Plateforme interfacultaire en économie et management de la santé, University of Lausanne, Lausanne, Switzerland. 9. Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland. 10. Emergency Department, Lausanne University Hospital, Lausanne, Switzerland. 11. Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.
Abstract
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.
RCT Entities:
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.
Entities:
Keywords:
case management; clinical trials; utilization; vulnerable populations
Authors: Nancy D Berkman; Stacey L Sheridan; Katrina E Donahue; David J Halpern; Karen Crotty Journal: Ann Intern Med Date: 2011-07-19 Impact factor: 25.391
Authors: Bienvenido Sanchez; Alexandre H Hirzel; Roland Bingisser; Annette Ciurea; Aris Exadaktylos; Beat Lehmann; Hans Matter; Kaspar Meier; Joseph Osterwalder; Robert Sieber; Bertrand Yersin; Carlos A Camargo; Olivier Hugli Journal: Int J Emerg Med Date: 2013-07-10
Authors: Catherine Hudon; Maud-Christine Chouinard; Kris Aubrey-Bassler; Nazeem Muhajarine; Fred Burge; Paula Louise Bush; Alya Danish; Vivian R Ramsden; France Légaré; Line Guénette; Paul Morin; Mireille Lambert; Fiona Fick; Olivia Cleary; Véronique Sabourin; Mike Warren; Pierre Pluye Journal: Ann Fam Med Date: 2020-05 Impact factor: 5.166
Authors: Catherine Hudon; Maud-Christine Chouinard; Pierre Pluye; Reem El Sherif; Paula Louise Bush; Benoît Rihoux; Marie-Eve Poitras; Mireille Lambert; Hervé Tchala Vignon Zomahoun; France Légaré Journal: Ann Fam Med Date: 2019-09 Impact factor: 5.166