Frequent Users of Emergency Department (FUEDs)
Conditions
Keywords
frequent users, emergency department, case-management program, RE-AIM, cost-effectiveness
Brief summary
The DAUM case-management program for frequent users (FUs) of emergency department was developed to improve FUs identification and management. FUs were eligible if they had four ED visits or more in the previous year, and attended the ED between November, 2022 and October, 2023. Patients were identified in the ED and addressed to the territorial support platform. A personalized health coordination plan which included a care plan (care objectives) and a support plan (social objectives) was co-constructed by the support platform, the patient, their caregiver(s), and their GP. Follow-up assessments at three to six months and at one year evaluated whether individual objectives were achieved. The primary outcomes were participants' mean number of ED visits during their year of participation in the program compared to the previous year, and the incremental cost-effectiveness ratio (ICER), expressed as the cost per ED visit avoided. Secondary outcomes included reach, adoption, implementation, and maintenance indicators.
Interventions
BEHAVIORALCase-management program
FUs patients were identified by the admission nurse through an alert generated by the ED information system. The ED physician explained the DAUM program to the patient and notified the Territorial Support Platform (TSP). The TSP team contacted the patient and his/her GP to present the DAUM program, obtain their agreement to participate and collect additional information. Once the patient included in the DAUM program, a Personalized Health Coordination Plan (PHCP) was co-constructed by the TSP team, in collaboration with the patient, hi/her GP, and other caregiver(s). The PHCP is divided into a care plan (with care objectives) and a support plan (with social obectives). Once the objectives of the care and support plans were identified for a patient, specific actions and timeframes were established for each objective. Follow-up assessments were conducted at three to six months from the inclusion and at one year.
Sponsors
Central Hospital, Nancy, France
agence régionale de santé Grand Est
Dispositif d'appui à la coordination de Meurthe-et-Moselle
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adults * who visited the ED of Nancy University Hospital between November 7th, 2022, and October 6th, 2023 * with at least four ED visits during the preceding year * residing in Nancy or the surrounding urban areas
Exclusion criteria
* homeless patients * patient refusal to participate * patient's GP refusal to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Effectiveness | Before-after comparison between the mean number of ED visits during the year of program participation and the mean number of ED visits in the preceding year | Mean number of ED visits among included patients |
| Cost-effectiveness | One year | Incremental cost-effectiveness ratio in cost per ED visit avoided |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients | One year | \[number of patients who consented to participate in the DAUM program / number of eligible patients\] x 100 |
| Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed | One year | \[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed\] x 100 |
| Indicator Reach 3 - Percentage of patients who effectively participated in the program | One year | \[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients\] x 100 |
| Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians | One year | \[number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)\] x 100 |
| Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit | One year | \[number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP\] x 100 |
| Indicator Implementation 1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit | One year | \[number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians\] x 100 |
| Indicator Implementation 2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician | One year | \[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients\] x 100 |
| Indicator Implementation 3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician | One year | \[number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed\] x 100 |
| Indicator Implementation 4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient | One year | \[number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP\] x 100 |
| Indicator Implementation 5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation | One year | \[number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated\] x 100 |
| Indicator Implementation 6 - Percentage of patients with a 3- to 6-month assessment | 3 and 6 months | \[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated\] x 100 |
| Indicator Implementation 7 - Percentage of patients with a 1-year assessment | One year | \[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year\] x 100 |
| Indicator Implementation 8 - Percentage of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment | One year | \[number of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment / number of patients followed-up at 1 year\] x 100 |
| Indicator Maintenance R1 - Percentage of patients who consented to participate in the DAUM program among eligible patients | One year | \[number of patients who consented to participate in the DAUM program / number of eligible patients\] x 100, calculated each month |
| Indicator Maintenance R2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed | One year | \[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed\] x 100, calculated each month |
| Indicator Maintenance R3 - Percentage of patients who effectively participated in the program | One year | \[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients\] x 100, calculated each month |
| Indicator Maintenance A1 - Percentage of patients notified to the TSP by ED physicians | One year | \[number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)\] x 100, calculated each month |
| Indicator Maintenance A2 - Percentage of patients who had been informed about the program during their ED visit | One year | \[number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP\] x 100, calculated each month |
| Indicator Maintenance I1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit | One year | \[number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians\] x 100, calculated each month |
| Indicator Maintenance I2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician | One year | \[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients\] x 100, calculated each month |
| Indicator Maintenance I3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician | One year | \[number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed\] x 100, calculated each month |
| Indicator Maintenance I4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient | One year | \[number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP\] x 100, calculated each month |
| Indicator Maintenance I5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation | One year | \[number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated\] x 100, calculated each month |
| Indicator Maintenance I6 - Percentage of patients with a 3- to 6-month assessment | One year | \[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated\] x 100, calculated each month |
| Indicator Maintenance I7 - Percentage of patients with a 1-year assessment | One year | \[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year\] x 100, calculated each month |
Countries
France
Outcome results
None listed