Randomized Controlled Trial

. 2017 May;32(5):508-515.

doi: 10.1007/s11606-016-3789-9. Epub 2016 Jul 11.

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

Affiliations

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.

PMID: 27400922
PMCID: PMC5400747
DOI: 10.1007/s11606-016-3789-9

Randomized Controlled Trial

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

Patrick Bodenmann et al. J Gen Intern Med. 2017 May.

. 2017 May;32(5):508-515.

doi: 10.1007/s11606-016-3789-9. Epub 2016 Jul 11.

Authors

Affiliations

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.

PMID: 27400922
PMCID: PMC5400747
DOI: 10.1007/s11606-016-3789-9

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.

Keywords: case management; clinical trials; utilization; vulnerable populations.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

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Comment in

Capsule Commentary on Bodenmann et al., Case Management May Reduce Emergency Department Frequent Use in a Universal Health Coverage System: a Randomized Controlled Trial.
Gregory B. Gregory B. J Gen Intern Med. 2017 May;32(5):556. doi: 10.1007/s11606-016-3829-5. J Gen Intern Med. 2017. PMID: 27496145 Free PMC article. No abstract available.

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical