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Implementing a case management intervention for frequent users of the emergency department: a multicenter study in Switzerland (I-CaM)

English title Implementing a case management intervention for frequent users of the emergency department: a multicenter study in Switzerland (I-CaM)
Applicant Bodenmann Patrick
Number 167341
Funding scheme NRP 74 Smarter Health Care
Research institution Policlinique Médicale Universitaire PMU
Institution of higher education University of Lausanne - LA
Main discipline Public Health and Health Services
Start/End 01.09.2017 - 30.09.2022
Approved amount 394'220.00
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Keywords (4)

Case management; emergency department; frequent users; implementation science

Lay Summary (French)

Lead
Titre originalImplementing a case management intervention for frequent users of the emergency department: a multicenter study in Switzerland (I-CaM)Recours à la gestion de cas pour décharger les urgencesLa plupart des services d’urgences en Suisse sont surchargés. Les patient-e-s qui recourent aux services d’urgences plus fréquemment que la moyenne expliquent une partie de ce phénomène. L’introduction d’une intervention de type gestion de cas doit pouvoir contribuer à améliorer cette situation.
Lay summary

Portrait / description du projet (projet de recherche en cours)

 

Cette gestion de cas s’adresse aux patient-e-s usagers fréquents des urgences qui se rendent au minimum cinq fois par année aux secteurs d’urgences. La gestion de cas se réalisera en fonction des hôpitaux avec trois degrés d’intensité : le premier groupe d’hôpitaux bénéficiera d’un soutien fort de type gestion de cas lausannois, le second d’un soutien plus léger et le troisième suivra ses pratiques habituelles. La mise en œuvre de la gestion de cas sera réévaluée dans les trois cas, au travers du recours aux services d’urgences et aux prestations médicales sociales, de la qualité de vie des personnes suivies par les équipes de gestion de cas ainsi que des coûts liés à ces différentes interventions. 

Contexte

Les services d’urgences en Suisse sont sollicités à l’excès par un petit groupe de patient-e-s. Au sein du centre hospitalier universitaire vaudois, ce groupe bien que ne représentant que 4 % des patient-e-s, génère 12 % des consultations souvent dans le cadre de maladies chroniques, de maladies psychiques associées à des addictions, et d’une complexité socio-économique majeure. Les études réalisées à ce jour montrent que l’introduction d’une intervention de type gestion de cas pour les usagers fréquents des urgences peut contribuer à alléger la surcharge des services d’urgences.

Objectif

Cette étude vise à l’implémentation de la gestion de cas pour les usagers fréquents des urgences au sein de différentes structures d’urgences. L’objectif est de l’introduire de manière graduelle dans différents hôpitaux de la suisse romande afin d’étudier sa mise en œuvre et ses effets.

Importance / Application

Un modèle est élaboré qui permet d’éviter le recours excessif aux services d’urgences en Suisse et qui permet de diriger les usagers réguliers souffrant de problèmes de santé complexes vers des offres plus adaptées. Ce modèle peut s’appliquer à tous les services d’urgences de Suisse et ainsi les décharger.

Direct link to Lay Summary Last update: 03.10.2017

Responsible applicant and co-applicants

Employees

Project partner

Publications

Publication
Health care providers’ perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland
Chastonay Oriane J., Lemoine Melissa, Grazioli Véronique S., Canepa Allen Marina, Kasztura Miriam, Moullin Joanna C., Daeppen Jean-Bernard, Hugli Olivier, Bodenmann Patrick (2021), Health care providers’ perception of the frequent emergency department user issue and of targeted case management interventions: a cross-sectional national survey in Switzerland, in BMC Emergency Medicine, 21(1), 4-4.
Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception
von Allmen Michael, Grazioli Véronique S., Kasztura Miriam, Chastonay Oriane, Moullin Joanna C., Hugli Olivier, Daeppen Jean-Bernard, Bodenmann Patrick (2021), Does Case Management Provide Support for Staff Facing Frequent Users of Emergency Departments? A Comparative Mixed-Method Evaluation of ED Staff Perception, in BMC Emergency Medicine, 21(1), 92-92.
Qualitative evaluation of primary care providers’ experiences caring for frequent users of the emergency department
Brunner Laureline, Canepa Allen Marina, Malebranche Mary, Hudon Catherine, Senn Nicolas, Hugli Olivier, Vu Francis, Akré Christina, Bodenmann Patrick (2021), Qualitative evaluation of primary care providers’ experiences caring for frequent users of the emergency department, in BMJ Open, 11(6), e044326-e044326.
Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study
Bodenmann Patrick, Kasztura Miriam, Graells Madison, Schmutz Elodie, Chastonay Oriane, Canepa-Allen Marina, Moullin Joanna, von Allmen Michael, Lemoine Melissa, Hugli Olivier, Daeppen Jean-Bernard, Grazioli Véronique S. (2021), Healthcare Providers’ Perceptions of Challenges with Frequent Users of Emergency Department Care in Switzerland: A Qualitative Study, in INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 0046958021-0046958021.
Case management for frequent emergency department users: no longer a question of if but when, where and how
Malebranche Mary, Grazioli Véronique S., Kasztura Miriam, Hudon Catherine, Bodenmann Patrick (2021), Case management for frequent emergency department users: no longer a question of if but when, where and how, in Canadian Journal of Emergency Medicine, 23(1), 12-14.
Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol
Grazioli Véronique S., Moullin Joanna C., Kasztura Miriam, Canepa-Allen Marina, Hugli Olivier, Griffin Judy, Vu Francis, Hudon Catherine, Jackson Yves, Wolff Hans, Burnand Bernard, Daeppen Jean-Bernard, Bodenmann Patrick (2019), Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol, in BMC Health Services Research, 19(1), 28-28.

Collaboration

Group / person Country
Types of collaboration
Hôpital du Jura Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital d'Yverdon (EHNV) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpitaux Universitaires de Genève Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital Intercantonal de la Broye (HIB) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital de Fribourg Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital de Neuchâtel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital du Valais Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Hôpital du Jura Bernois Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
SBK-ASI Congress Talk given at a conference Case management für häufige nutzer von notfallstationed 18.05.2021 Basel, Switzerland Kasztura Miriam;
Society of General Internal Medicine Poster Emergency department healthcare providers’ perceptions of difficulties related to frequent users’ attendance 20.04.2021 On-line, United States of America Grazioli Véronique; Bodenmann Patrick;
12th European Public Health Conference Poster Does case management provide support for staff facing frequent users of emergency department? 20.11.2019 Marseille, France Grazioli Véronique; Kasztura Miriam;
12th European Public Health Conference Poster Healthcare providers' perceptions of difficulties related to frequent users of emergency department 20.11.2019 Marseille, France Grazioli Véronique; Kasztura Miriam;
International Council of Nurses Congress Poster I-CaM: Overview of a research project implementing case management for frequent users of emergency departements 27.06.2019 Singapoure, Singapore Kasztura Miriam;
Swiss Society of General Internal Medicine Talk given at a conference Health care providers’ perceptions of difficulties related to frequent users of the emergency department in Switzerland: A qualitative survey in Western Switzerland 31.05.2018 Basel, Switzerland Kasztura Miriam; Grazioli Véronique; Daeppen Jean-Bernard; Bodenmann Patrick; Canepa Allen Marina; Hügli Olivier;
Swiss Society of General Internal Medicine Poster Health staff perceptions of emergency department frequent users in French-speaking Switzerland: A quantitative study 30.05.2018 Basel, Switzerland Kasztura Miriam; Canepa Allen Marina; Grazioli Véronique; Bodenmann Patrick; Hügli Olivier; Daeppen Jean-Bernard;


Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
Workshop on case management intervention Workshop 16.12.2019 Unisanté, Switzerland Grazioli Véronique; Kasztura Miriam; Bodenmann Patrick;
Workshop on case management intervention Workshop 13.06.2019 Unisanté, Switzerland Grazioli Véronique; Kasztura Miriam; Bodenmann Patrick;
Workshop on case management intervention Workshop 14.02.2019 Unisanté, Switzerland Kasztura Miriam; Grazioli Véronique; Bodenmann Patrick;
Workshop on case management intervention Workshop 30.08.2018 Lausanne, PMU, Switzerland Hügli Olivier; Kasztura Miriam; Bodenmann Patrick; Grazioli Véronique;
Workshop on case-management intervention implementation Workshop 29.05.2018 Lausanne, Policlinique Médicale Universitaire, Switzerland Kasztura Miriam; Bodenmann Patrick; Hügli Olivier; Grazioli Véronique;
Workshop on case-management intervention implementation Workshop 05.02.2018 Lausanne, Policlinique Médicale Universitaire, Switzerland Bodenmann Patrick; Grazioli Véronique; Kasztura Miriam; Canepa Allen Marina; Hügli Olivier;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media A Payerne on prend le pouls des "abonnés aux urgences" 24 Heures Western Switzerland 2019
Media relations: print media, online media L'HIB se penche sur les hauts consommateurs des urgences Intranet HIB Western Switzerland 2019
Media relations: radio, television Rencontre avec Patrick Bodenmann, un spécialiste des populations vulnérables CQFD, RTS Western Switzerland 2018

Abstract

Background: Frequent users of the emergency department (ED) and other health care services are of much interest to clinicians, administrators and researchers. Emergency department overuse is linked to ED overcrowding, which in turn has a negative impact on patient and health system outcomes. There are over 1.4 million annual ED visits in Switzerland, with 84% of EDs reporting overcrowding. Frequent ED users made up 4.4% of the patient population and made 12.1% of all visits at the Lausanne University Hospital ED. Driving this high use of health care services is the fact that frequent ED users suffer from chronic medical diseases, including heart disease, pulmonary disease and cancer, at high rates, in addition to mental illness and substance use disorders more commonly associated with frequent ED users. Case management (CM) has been shown to be a cost-effective intervention to reduce ED overuse by frequent users in research settings; however, there is limited knowledge about how to disseminate and implement a CM intervention for ED frequent users on a large scale to diverse clinical settings, including community hospitals and non-academic centers. Aim: The objectives of this project are to: (1) develop and disseminate a practical ‘CM intervention for frequent ED users’ program to several hospitals in the French-speaking region of Switzerland; (2) study the process of implementation of the intervention; and (3) study the impact of the CM intervention on health services outcomes including ED use, health care re-orientation, quality of life and cost. Methods: This project uses a hybrid study design, measuring both health service and implementation outcomes, relating to the dissemination and implementation of a CM intervention program for frequent ED users at multiple sites in French-speaking Switzerland. The interdisciplinary, individualized CM intervention will target frequent users with 5 or more ED visits in the past 12 months. The CM intervention will be modeled on our prior research to provide tailored support to access all necessary somatic and mental health services, substance abuse treatment and social services. All hospitals in the French-speaking region of Switzerland will be eligible to participate in this project. Sites will be randomized into three groups, which will receive different levels of implementation support from the research team (no coaching, non-intensive coaching or intensive coaching). All groups will receive a CM toolkit to assist in the development of CM team and program at their site. The project will be conducted over five phases (Development, Exploration, Preparation, Operation, Sustainability, over a 42-month period, with an additional 6-month period for final analyses (total project duration 48 months). Outcome measures:I. Implementation Outcomes1)Level of Awareness: the number of hospitals contacted divided by the total number of eligible hospitals2)Level of Adoption: the number of sites that decide to adopt the CM intervention divided by the total number of hospitals contacted about the project3)Level of Provision: a)Reach of Intervention (among frequent ED users): total number of frequent users at each site, how many interested in CM, how many use CM services/complete CM intervention b)Fidelity of Implementation: degree to which the CM intervention is implemented as it was originally designed; measured by checklists or by observation (Coach or member of research team during site visits)4)Identifying factors (facilitators and barriers): using existing questionnaires (e.g. Consolidated Framework for Implementation (CFIR) tools) and/or Coach performing semi-structured interviews to elicit factors and offer feedback (Groups 2 & 3)5)Level of Normalization: measure of integration and/or support for intervention (e.g. Normalization Process Theory (NPT) tool)6)Cost assessment of implementation programB. Health Service Outcomes1) Emergency department utilization2) Health care re-orientation: referral to new PCP, medical or mental health specialist, social services3) Quality of life: using WHO-QoL, Euro-QoL4) Cost: hospital-level costs measured Expected benefits and applications: ED services overuse and overcrowding is a critical problem in Switzerland, and this project promotes a highly practical and relevant solution. There is a strong link between chronic disease and frequent ED use, driven largely by the medical and social complexity of these patients. Addressing ED overuse through CM redirects frequent users to more appropriate forms of care, including primary care or substance abuse treatment, while remaining cost-effective. By developing a CM intervention program and studying its implementation at multiple sites, this project will provide insights and lessons for the broader use of CM interventions for health care services overuse throughout Switzerland.
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