Case Management for Frequent Users of the Emergency Department

Vulnerable Populations Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01934322
• Other study ID #: FNS 30023B_135762/1
• Status: Completed
• Phase: N/A
• First received: August 29, 2013
• Last updated: May 26, 2015
• Start date: June 2012
• Est. completion date: July 2014

Study information

• Verified date: May 2015
• Source: University of Lausanne
• Contact: n/a
• Is FDA regulated: No
• Health authority: Switzerland: Ethikkommission
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 250
• Est. completion date: July 2014
• Est. primary completion date: July 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

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

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Supportive Care

Related Conditions & MeSH terms

• Emergencies
• Frequent Users of the Emergency Department
• Vulnerable Populations

Intervention

Other:
• Case Management
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.

Locations

Country	Name	City	State
Switzerland	University Hospital of Lausanne	Lausanne

Sponsors (1)

Lead Sponsor	Collaborator
University of Lausanne

Country where clinical trial is conducted

Switzerland, 

References & Publications (4)

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. Review. — View 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. — View 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. — View 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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Quality of life		Day of enrollement, 2 months, 5.5 months, 9 months and 12 months	No
Primary	number of Emergency Department visits		12 months after enrollement	No
Secondary	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	No