Case Management for Frequent Users of the Emergency Department

Study Overview
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Brief Summary
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The purpose of this study is to evaluate a specific case management intervention for frequent users (FU) of Emergency Department (ED). Compared to infrequent or non-users, most of the ED-FU visitors are identified as vulnerable patients because they are more likely to be of low social and economical status, be more isolated and live alone. They report more chronic medical conditions, have a higher mortality rate and consume more healthcare resources. In the literature, interventions aimed at improving the management of ED-FU have demonstrated several positive outcomes, but there are still some knowledge gaps. The proposed project tests the hypotheses that case management intervention as compared with standard emergency care is a more efficient use of healthcare resources and reduces ED attendance, is cost-saving and improves quality of life, altogether leading to favorable cost-utility ratio.

Official Title
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Case Management for Frequent Users of the Emergency Department: A Randomized Controlled Trial

Conditions
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Frequent Users of the Emergency Department, Vulnerable Populations

Intervention / Treatment
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* Other: Case Management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 5 or more attendances during the previous 12 months at the Emergency Department of the University Hospital of Lausanne Be capable of communicating in any of the languages spoken by the team (i.e. French, English, German, Italian and Spanish) or through a community interpreter Exclusion Criteria: Patients who cannot give informed consent or are ineligible to receive Case Managers services (e.g. acutely confused, acutely psychotic, intoxicated) Patients who are in prison Patients with a diagnose of cognitive disorders (delirium, dementia, and other cognitive disorders) Patients who are not expected to survive at least 18 months after enrollment Patients who will not remain in Switzerland for 12 to 18 months after enrollment Family members of a participant already included

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Case Management<br>Furnish specific assistance and to provide referrals for the patients: If the social determinants are not adequate, the team will lend assistance for obtaining income entitlements, health insurance coverage if eligible, stable housing, schooling for children, etc. If there are mental disturbances, the team will refer to mental health departments inside the hospital, and if necessary, to a psychiatrist, psychologist or general practitioner (GP) out in the community. If the patient presents risk behaviors, the team will refer to substance abuse services and links to community services in order to maintain continuity of care. In case of somatic problems, the team will find a new GP or make contact with the previous provider, contingent on the patient's consent. | Other: Case Management<br>* Furnish specific assistance and to provide referrals for the patients: If the social determinants are not adequate, the team will lend assistance for obtaining income entitlements, health insurance coverage if eligible, stable housing, schooling for children, etc. If there are mental disturbances, the team will refer to mental health departments inside the hospital, and if necessary, to a psychiatrist, psychologist or general practitioner (GP) out in the community. If the patient presents risk behaviors, the team will refer to substance abuse services and links to community services in order to maintain continuity of care. In case of somatic problems, the team will find a new GP or make contact with the previous provider, contingent on the patient's consent.<br>|
| No Intervention: Control<br>Patients randomized to control group (usual care) will receive standard emergency care by physicians (resident or attending physician) and nurses, without the case manager been involved. Nevertheless, the mobile team will take contact with each patient of the control group, giving them short information through a flyer (flyer) which will underline the existence of the mobile team, its addresses and telephone numbers. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| number of Emergency Department visits |  | 12 months after enrollement | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| total costs of the healthcare resource | costs concerning services provided by the University Hospital of Lausanne and cost concerning services used outside the Hospital | 12 months after enrollement | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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frequent users of the emergency department, vulnerable populations, case management, cost savings intervention, quality of life, number of emergency department visits