Clinical trial NCT01934322: Case Management for Frequent Users of the Emergency Department
Official title: Case Management for Frequent Users of the Emergency Department: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Frequent Users of the Emergency Department
Vulnerable Populations
Keywords: frequent users of the emergency department
vulnerable populations
case management
cost savings intervention
quality of life
number of emergency department visits
Lead sponsor: University of Lausanne
Sponsor class: OTHER
First posted: 2013-09-04
Enrollment: 250
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: 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.


Eligibility criteria: 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

Primary outcomes:
measure: number of Emergency Department visits
timeFrame: 12 months after enrollement
Secondary outcomes:
measure: total costs of the healthcare resource
timeFrame: 12 months after enrollement
Other outcomes:
measure: Quality of life
timeFrame: Day of enrollement, 2 months, 5.5 months, 9 months and 12 months
Locations:
city: Lausanne
country: Switzerland
facility: University Hospital of Lausanne
Study officials:
affiliation: University of Lausanne
name: Bodenmann Patrick, PD, MER, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Althaus F, Paroz S, Hugli O, Ghali WA, Daeppen JB, Peytremann-Bridevaux I, Bodenmann P. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med. 2011 Jul;58(1):41-52.e42. doi: 10.1016/j.annemergmed.2011.03.007.
citation: Bieler G, Paroz S, Faouzi M, Trueb L, Vaucher P, Althaus F, Daeppen JB, Bodenmann P. Social and medical vulnerability factors of emergency department frequent users in a universal health insurance system. Acad Emerg Med. 2012 Jan;19(1):63-8. doi: 10.1111/j.1553-2712.2011.01246.x. Epub 2012 Jan 5.
citation: Althaus F, Stucki S, Guyot S, Trueb L, Moschetti K, Daeppen JB, Bodenmann P. Characteristics of highly frequent users of a Swiss academic emergency department: a retrospective consecutive case series. Eur J Emerg Med. 2013 Dec;20(6):413-9. doi: 10.1097/MEJ.0b013e32835e078e.
citation: Shumway M, Boccellari A, O'Brien K, Okin RL. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. Am J Emerg Med. 2008 Feb;26(2):155-64. doi: 10.1016/j.ajem.2007.04.021.
citation: Iglesias K, Baggio S, Moschetti K, Wasserfallen JB, Hugli O, Daeppen JB, Burnand B, Bodenmann P. Using case management in a universal health coverage system to improve quality of life of frequent Emergency Department users: a randomized controlled trial. Qual Life Res. 2018 Feb;27(2):503-513. doi: 10.1007/s11136-017-1739-6. Epub 2017 Nov 29.
citation: Bodenmann P, Velonaki VS, Ruggeri O, Hugli O, Burnand B, Wasserfallen JB, Moschetti K, Iglesias K, Baggio S, Daeppen JB. Case management for frequent users of the emergency department: study protocol of a randomised controlled trial. BMC Health Serv Res. 2014 Jun 17;14:264. doi: 10.1186/1472-6963-14-264.