A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors: results from an adaptive randomized trial.

Source: Edgren, G., et al. 2016 - Pubmed ID: 25969342

Setting: Sweden, Hospitals from 3 counties

Study design:

RCT

Follow up:
– Until Death or
– Until End of study (march 2014) or
– Maxi-mum two years.

Patient group:

Sample size:

Total: 12181 (8536)

IG: 8214 (4569)

– site a 7280 (3635)

– site b 934

CG: 3967 (3967)

– site a 3508

– site b 459

Inclusion criteria:

3 or more emergency visits during previous 6 months.

Type of technology:

Phone call

– Coaching disease self-management

– Support interaction with social services

– Facilitated contacts with healthcare providers.

Intervention:

Intervention:

Patient and nurse meet for interview of patient’s medical and social history. This information was used to guide the intervention. Telephone contact was made on a regular basis. Nurses facilitated contacts with healthcare providers, coached patients’ disease self-management, and supported interactions with social services.

Duration: max 2 years

Add on: +

Control group:

No intervention

Clinical effect/ Patient safety:

Clinical effect:

– Risk of hospitalization:

Site a →

Site b ↓

Patient safety:

NA

Patient experiences/ Staff experiences:

Patient experiences:

NA

Staff experiences:

NA

Costs and organization:

Investment:

Staff resources

– Nurses were employed by a private entity (Health navigator.)

– Training nurses

Running:

Staff resources

– Nurses for interview and telephone call

Organization:

– Development of new skills (nurses)

Health care utilization:

Total healthcare costs →

Number of days in hospital →

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Information

“↑”: Statistically significant increase

“↓”: Statistically significant decrease

“→”: Statistically insignificant (no difference)