Frequent Users of the Emergency Department, Vulnerable Populations
Conditions
Keywords
frequent users of the emergency department, vulnerable populations, case management, cost savings intervention, quality of life, number of emergency department visits
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.
Interventions
OTHERCase 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.
Sponsors
University of Lausanne
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| number of Emergency Department visits | 12 months after enrollement |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| total costs of the healthcare resource | 12 months after enrollement | costs concerning services provided by the University Hospital of Lausanne and cost concerning services used outside the Hospital |
Other
| Measure | Time frame |
|---|---|
| Quality of life | Day of enrollement, 2 months, 5.5 months, 9 months and 12 months |
Countries
Switzerland
Outcome results
None listed