Case management; emergency department; frequent users; implementation science
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.
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.
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.
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.
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.
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.
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.