Case Management for Frequent Users of the Emergency Department: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 250
- 试验地点
- 1
- 主要终点
- number of Emergency Department visits
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •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
研究组 & 干预措施
Case 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.
干预措施: Case Management (Other)
Control
Patients randomized to control group (usual care) will receive standard emergency care by physicians (resident or attending physician) and nurses, without the case manager been involved. Nevertheless, the mobile team will take contact with each patient of the control group, giving them short information through a flyer (flyer) which will underline the existence of the mobile team, its addresses and telephone numbers.
结局指标
主要结局
number of Emergency Department visits
时间窗: 12 months after enrollement
次要结局
- total costs of the healthcare resource(12 months after enrollement)
研究者
Dr Patrick Bodenmann
PD, MER, MSc
University of Lausanne