***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Frequent emergency department ( ED ) users account for a disproportionately high number of ED visits . Studies on case management ( CM ) interventions to reduce frequent ED use have shown mixed results , and few studies have been conducted within a universal health coverage system . Objective To determine whether a CM intervention — compared to st and ard emergency care — reduces ED attendance . Design R and omized controlled trial . Participants Two hundred fifty frequent ED users ( 5 or more visits in the prior 12 months ) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention ( n = 125 ) or control ( n = 125 ) group , and monitored for 12 months . Interventions An individualized CM intervention consisting of concrete assistance in obtaining income entitlements , referral to primary or specialty medical care , access to mental health care or substance abuse treatment , and counseling on at-risk behaviors and health care utilization ( in addition to st and ard care ) at baseline and 1 , 3 , and 5 months . Main Measures We used a generalized linear model for count data ( negative binomial distribution ) to compare the number of ED visits during the 12-month follow-up between CM and usual care , from an intention-to-treat perspective . Key Results At 12 months , there were 2.71 ( ±0.23 ) ED visits in the intervention group versus 3.35 ( ±0.32 ) visits among controls ( ratio = 0.81 , 95 % CI = 0.63 ; 1.02 ) . In the multivariate model , the effect of the CM intervention on the number of ED visits approached statistical significance ( b = −0.219 , p = 0.075 ) . The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model ( b = 0.280 , p = 0.048 ) . Conclusions CM may reduce ED use by frequent users through an improved orientation to the health care system . Poor social determinants of health significantly increase use of the ED by frequent users Background A small group of frequent visitors to emergency departments accounts for a disproportional large number of total emergency department visits . Previous interventions in this population have shown mixed results . Objective To determine whether a nurse-managed telephone-based case-management intervention can reduce healthcare utilization and improve self-assessed health status in frequent emergency department users . Methods We carried out a Zelen- design r and omized-controlled trial among patients who were identified as frequent emergency department users ( ≥3 visits during the 6 months before inclusion ) at the Karolinska University Hospital in Stockholm ( Sweden ) . Patients included in the study ( n=268 ) were r and omized to either the intervention group or the control group and followed for 1 year . Patients who declined to participate or could not be reached were also followed for the study outcome . Results The telephone-based case-management intervention  reduced the total number of outpatient visits ( relative risk 0.80 ; 95 % confidence interval 0.75–0.84 ) , the number of emergency department visits ( relative risk 0.77 ; 95 % confidence interval 0.69–0.86 ) , the number of days patients were admitted to hospitals as well as the total healthcare costs for hospital admissions . There was no difference in mortality or other identified adverse outcomes between the intervention and the control groups . Patient self-assessed health status improved for the patients who received the case-management intervention . Conclusion Our results indicate that the nurse-managed telephone-based case-management intervention represents a possible strategy to improve care for frequent emergency department users as well as decrease outpatient visits , admission days and healthcare costs Background We devised a r and omised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users . The aim of the intervention is to reduce such patients ’ emergency department use , to improve their quality of life , and to reduce costs consequent on frequent use . The intervention consists of a combination of comprehensive case management care and st and ard emergency care . It uses a clinical case management model that is patient-identified , patient-directed , and developed to provide high intensity services . It provides a continuum of hospital- and community-based patient services , which include clinical assessment , outreach referral , and coordination and communication with other service providers . Methods / Design We aim to recruit , during the first year of the study , 250 patients who visit the emergency department of the University Hospital of Lausanne , Switzerl and . Eligible patients will have visited the emergency department 5 or more times during the previous 12 months . R and omisation of the participants to the intervention or control groups will be computer generated and concealed . The statistician and each patient will be blinded to the patient ’s allocation . Participants in the intervention group ( N = 125 ) , additionally to st and ard emergency care  , will receive case management from a team , 1 ( ambulatory care ) to 3 ( hospitalization ) times during their stay and after 1 , 3 , and 5 months , at their residence , in the hospital or in the ambulatory care setting . In between the consultations provided , the patients will have the opportunity to contact , at any moment , the case management team . Participants in the control group ( N = 125 ) will receive st and ard emergency care only . Data will be collected at baseline and 2 , 5.5 , 9 , and 12 months later , including : number of emergency department visits , quality of life ( EuroQOL and WHOQOL ) , health services use , and relevant costs . Data on feelings of discrimination and patient ’s satisfaction will also be collected at the baseline and 12 months later . Discussion Our study will help to clarify knowledge gaps regarding the positive outcomes ( emergency department visits , quality of life , efficiency , and cost-utility ) of an intervention based on case management care . Trial registration Clinical Trials.gov Identifier : NCT01934322 Background A small group of frequent visitors to Emergency Departments accounts for a disproportionally large fraction of healthcare consumption including unplanned hospitalizations and overall healthcare costs . In response , several case and disease management programs aim ed at reducing healthcare consumption in this group have been tested ; however , results vary widely . Objectives To investigate whether a telephone-based , nurse-led case management intervention can reduce healthcare consumption for frequent Emergency Department visitors in a large-scale setup . Methods A total of 12 181 frequent Emergency Department users in three counties in Sweden were r and omized using Zelen ’s design or a traditional r and omized design to receive either a nurse-led case management intervention or no intervention , and were followed for healthcare consumption for up to 2 years . Results The traditional design showed an overall 12 % ( 95 % confidence interval 4–19 % ) decreased rate of hospitalization , which was mostly driven by effects in the last year . Similar results were achieved in the Zelen studies , with a significant reduction in hospitalization in the last year , but mixed results in the early development of the project . Conclusion Our study provides evidence that a carefully design ed telephone-based intervention with accurate and systematic patient selection and appropriate staff training in a central ized setup can lead to significant decreases in healthcare consumption and costs . Further , our results also show that the effects are sensitive to the delivery model chosen Background Patients with depression often have limited access to outpatient psychotherapy following inpatient treatment . The objective of the study was to evaluate the long-term effectiveness of a telephone-based aftercare case management ( ACM ) intervention for patients with depression . Methods We performed a prospect i ve r and omized controlled trial in four psychotherapeutic inpatient care units with N = 199 patients with major depression or dysthymia ( F32.x , F33.x , F34.1 , according to the ICD-10 ) . The ACM consisted of six phone contacts at two-week intervals performed by trained and certified psychotherapists . The control group received usual care ( UC ) . The primary outcome was depressive symptom severity ( BDI-II ) at 9-month follow-up , and secondary outcomes were health-related quality of life ( SF-8 , EQ-5D ) , self-efficacy ( SWE ) , and the proportion of patients initiating outpatient psychotherapy . Mixed model analyses were conducted to compare improvements between treatment groups . Results Regarding the primary outcome of symptom severity , the groups did not significantly differ after 3 months ( p = .132 ; ES = -0.23 ) or at the 9-month follow-up ( p = .284 ; ES = -0.20 ) . No significant differences in health-related quality of life or self-efficacy were found between groups . Patients receiving ACM were more likely to be in outpatient psychotherapy  after 3 months ( OR : 3.00[1.12–8.07 ] ; p = .029 ) and 9 months ( OR : 4.78 [ 1.55–14.74 ] ; p = .006 ) than those receiving UC . Conclusions Although telephone-based ACM did not significantly improve symptom severity , it seems to be a valuable approach for overcoming treatment barriers to the clinical pathways of patients with depression regarding their access to outpatient psychotherapy AIM To compare , over a 4-year period , a cohort of adult frequent attenders at Christchurch Hospital Emergency Department ( Christchurch , New Zeal and ) who received case management with a cohort who did not .  METHOD A descriptive prospect i ve cohort study of patients who attended ED 10 or more times during the index period of 1 Nov 2000 - 31 Oct 2001 was carried out . Each patient had an individual management plan .  Attendance patterns were compared with a previous 4-year study of patients without management plans which was performed in the same ED . This study acted as an historical control . RESULTS 87 patients who met the criteria for frequent attendance were compared with 77 patients in the control group .  10 patients remained frequent users for all 4 years of the study , compared with 9 in the control group . Most patients attended less frequently in the second year , with attendance rates continuing to fall , while a small group continued to make frequent presentations . The percentage of the cohort still attending ED at least once a year in the 4th year was nearly identical in each study ( 65 % in the control and 64 % in the intervention group ) ; the percentage of each cohort who remained as frequent attenders , still attending 10 or more times in the 4th year , was identical . CONCLUSIONS This study showed similar rates of attrition in ED attendance between the cohorts with and without management plans . If there were not a ' control ' group , the decline in attendance in the study group might have been attributed to the management plans . When attributing changes in attendance patterns to any intervention , it is important to be aware of natural attrition over time This study sought to determine whether homeless veterans entering Veterans Affairs ( VA ) substance use treatment r and omized to  intensive addiction/housing case management ( AHCM ) had improved housing , substance use , mental health , and functional outcomes and lower acute health care utilization , compared to a housing support group ( HSG ) control .  Homeless veterans ( n = 181 ) entering outpatient VA substance use treatment were r and omized to AHCM and HSG and received treatment for 12 months . AHCM provided individualized housing , substance use and mental health case management , life skills training , and community outreach . The control condition was a weekly drop-in housing support group . Adjusted longitudinal analyses compared groups on baseline to month 12 change in percentage of days housed and functional status , substance use , and mental health outcomes ( 36-Item Short-Form Health Survey ; Addiction Severity Index [ ASI ] ) . Negative binomial regression models compared groups on health care utilization . Both conditions significantly increased percentage of days housed , with no differences detected between conditions . In total , 74 ( 81.3 % ) AHCM and 64 ( 71.1 % ) HSG participants entered long-term housing ( odds ratio = 1.9 , 95 % confidence interval [ 0.9 , 4.0 ] , p = .088 ) . HSG participants experienced a greater decrease in emergency department visits than AHCM ( p = .037 ) , whereas AHCM participants remained in substance use treatment 52.7 days longer ( p = .005 ) and had greater study treatment participation ( p < .001 ) than HSG . ASI alcohol composite scores improved more for HSG than AHCM ( p = .006 ) , and both conditions improved on ASI drug and psychiatric scores and alcohol/drug abstinence .  AHCM did not demonstrate overarching benefits beyond st and ard VA housing and substance use care . For those veterans not entering or losing long-term housing , different approaches to outreach and ongoing intervention are required Objective Frequent users of healthcare services are a vulnerable population , often socioeconomically disadvantaged , who can present multiple chronic conditions as well as mental health problems . Case management ( CM ) is the most frequently performed intervention to reduce healthcare use and cost . This study aim ed to examine the evidence of the effectiveness of CM interventions for frequent users of healthcare services . Design Scoping review . Data sources An electronic literature search was conducted using the MEDLINE , Scopus and CINAHL data bases covering January 2004 to December 2015 . A specific search strategy was developed for each data base using keywords ‘ case management ’ and ‘ frequent use ’ . Eligibility criteria for selecting studies To be included in the review , studies had to report effects of a CM intervention on healthcare use and cost or patient outcomes . Eligible design s included r and omised and non-r and omised controlled trials and controlled and non-controlled before – after studies . Studies limited to specific groups of patients or targeting a single disease were excluded . Three review ers screened abstract s , screened each full-text article and extracted data , and discrepancies were resolved by consensus . Results The final review included 11 articles evaluating the effectiveness of  CM interventions among frequent users of healthcare services . Two non-r and omised controlled studies and 4 before – after studies reported positives outcomes on healthcare use or cost . Two r and omised controlled trials , 2 before – after studies and  
    Output:
    
The purpose is to examine how CM programs are implemented to reduce the number of FU visits to the ED