Patrick Bodenmann|Venetia-Sofia Velonaki|Judith L. Griffin|Stéphanie Baggio|Katia Iglesias|Karine Moschetti|Ornella Ruggeri|Bernard Burnand|Jean?Blaise Wasserfallen|Francis Vu|Joëlle Schüpbach|Olivier Hügli|Jean?Bernard Daeppen
Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial
University of Lausanne|University of Lausanne|University of Lausanne|University of Lausanne|University of Neuchâtel|Institute of Social and Preventive Medicine|Institute of Social and Preventive Medicine|University of Lausanne|University of Lausanne|Institute of Social and Preventive Medicine|University of Lausanne|University of Lausanne|University of Lausanne|University of Lausanne
frequent emergency department ed users account disproportionately high number ed visits studies case management cm interventions reduce frequent ed use shown mixed results studies conducted within universal health coverage systemto determine whether cm interventioncompared standard emergency carereduces ed attendancerandomized controlled trialtwo hundred fifty frequent ed users 5 visits prior 12 months visited public urban ed lausanne university hospital may 2012 july 2013 allocated either intervention n 125 control n 125 group monitored 12 monthsan individualized cm intervention consisting concrete assistance obtaining income entitlements referral primary specialty medical care access mental health care substance abuse treatment counseling atrisk behaviors health care utilization addition standard care baseline 1 3 5 monthswe used generalized linear model count data negative binomial distribution compare number ed visits 12month followup cm usual care intentiontotreat perspectiveat 12 months 271 023 ed visits intervention group versus 335 032 visits among controls ratio 081 95 ci 063 102 multivariate model effect cm intervention number ed visits approached statistical significance b 0219 p 0075 presence poor social determinants health significant predictor ed use multivariate model b 0280 p 0048cm may reduce ed use frequent users improved orientation health care system poor social determinants health significantly increase use ed frequent users