Case management intervention of high users of the emergency department of a Portuguese hospital: a before-after design analysis

• Published in: BMC emergency medicine Vol. 22; no. 1; pp. 1 - 159
• Main Authors: Gonçalves, Simão, von Hafe, Francisco, Martins, Flávio, Menino, Carla, Guimarães, Maria José, Mesquita, Andreia, Sampaio, Susana, Londral, Ana Rita
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 13-09-2022; BioMed Central; BMC
• Subjects: Case management; Case management; Integrated care; High users; Emergency department; Costs; Healthcare system sustainability; Collaboration; Cost control; Costs; Data analysis; Design analysis; Emergency medical care; Emergency medical services; Emergency service; Hospital costs; Hospitalization; Hospitals; Intervention; Patient satisfaction; Patient-centered care; Patients; Return on investment; Socioeconomic factors; Statistical analysis; Portugal
• DOI: 10.1186/s12873-022-00716-3
• EISSN: 1471-227X

Background Emergency department (ED) High users (HU), defined as having more than ten visits to the ED per year, are a small group of patients that use a significant proportion of ED resources. The High Users Resolution Group (GRHU) identifies and provides care to HU to improve their health conditions and reduce the frequency of ED visits by delivering patient-centered case management integrated care. The main objective of this study was to measure the impact of the GRHU intervention in reducing ED visits, outpatient appointments, and hospitalizations. As secondary objectives, we aimed to compare the GRHU intervention costs against its potential savings or additional costs. Finally, we intend to study the impact of this intervention across different groups of patients. Methods We studied the changes triggered by the GRHU program in a retrospective, non-controlled before-after analysis of patients' hospital utilization data on 6 and 12-month windows from the first appointment. Results A total of 238 ED HU were intervened. A sample of 152 and 88 patients was analyzed during the 6 and 12-month window, respectively. On the 12-month window, GRHU intervention was associated with a statistically significant reduction of 51% in ED visits and hospitalizations and a non-statistically significant increase in the total number of outpatient appointments. Overall costs were reduced by 43.56%. We estimated the intervention costs to be [euro]79,935.34. The net cost saving was [euro]104,305.25. The program's Return on Investment (ROI) was estimated to be [euro]2.3. Conclusion Patient-centered case management for ED HU seems to effectively reduce ED visits and hospitalizations, leading to better use of resources. Keywords: Case management; Integrated care; High users; Emergency department; Costs; Healthcare system sustainability