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Case Management for Frequent Users of the Emergency Department

Primary Purpose

Frequent Users of the Emergency Department, Vulnerable Populations

Status
Completed
Phase
Not Applicable
Locations
Switzerland
Study Type
Interventional
Intervention
Case Management
Sponsored by
University of Lausanne
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Frequent Users of the Emergency Department focused on measuring frequent users of the emergency department, vulnerable populations, case management, cost savings intervention, quality of life, number of emergency department visits

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

  • University Hospital of Lausanne

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Case Management

Control

Arm Description

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.

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.

Outcomes

Primary Outcome Measures

number of Emergency Department visits

Secondary Outcome Measures

total costs of the healthcare resource
costs concerning services provided by the University Hospital of Lausanne and cost concerning services used outside the Hospital

Full Information

First Posted
August 29, 2013
Last Updated
May 26, 2015
Sponsor
University of Lausanne
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1. Study Identification

Unique Protocol Identification Number
NCT01934322
Brief Title
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

2. Study Status

Record Verification Date
May 2015
Overall Recruitment Status
Completed
Study Start Date
June 2012 (undefined)
Primary Completion Date
July 2014 (Actual)
Study Completion Date
July 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Lausanne

4. Oversight

Data Monitoring Committee
No

5. Study Description

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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
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

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
250 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Case Management
Arm Type
Experimental
Arm Description
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.
Arm Title
Control
Arm Type
No Intervention
Arm Description
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.
Intervention Type
Other
Intervention Name(s)
Case Management
Intervention Description
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.
Primary Outcome Measure Information:
Title
number of Emergency Department visits
Time Frame
12 months after enrollement
Secondary Outcome Measure Information:
Title
total costs of the healthcare resource
Description
costs concerning services provided by the University Hospital of Lausanne and cost concerning services used outside the Hospital
Time Frame
12 months after enrollement
Other Pre-specified Outcome Measures:
Title
Quality of life
Time Frame
Day of enrollement, 2 months, 5.5 months, 9 months and 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bodenmann Patrick, PD, MER, MSc
Organizational Affiliation
University of Lausanne
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital of Lausanne
City
Lausanne
ZIP/Postal Code
1011
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
21689565
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.
Results Reference
background
PubMed Identifier
22221292
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.
Results Reference
background
PubMed Identifier
23337095
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.
Results Reference
background
PubMed Identifier
18272094
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.
Results Reference
background
PubMed Identifier
29188481
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.
Results Reference
derived
PubMed Identifier
24938769
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.
Results Reference
derived

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Case Management for Frequent Users of the Emergency Department

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