Case management for frequent users of the emergency department: study protocol of a randomised controlled trial
1 Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne CH-1015, Switzerland
2 Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne CH-1011, Switzerland
3 Emergency Department, Lausanne University Hospital, Lausanne CH-1011, Switzerland
4 Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne CH-1011, Switzerland
5 Health Technology Assessment Unit, University of Lausanne, Lausanne CH-1015, Switzerland
6 Institute of Health Economics and Management, University of Lausanne, Lausanne CH-1015, Switzerland
7 Life Course and Inequality Research Centre, Faculty of Social and Political Sciences, University of Lausanne, Lausanne CH-1015, Switzerland
8 Alcohol Treatment Service, Lausanne University Hospital, Lausanne CH-1011, Switzerland
BMC Health Services Research 2014, 14:264 doi:10.1186/1472-6963-14-264Published: 17 June 2014
We devised a randomised 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 standard 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.
We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation 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 standard 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 standard 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.
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.
ClinicalTrials.gov Identifier: NCT01934322.