FREQUENT USERS OF THE EMERGENCY DEPARTMENT - CAN WE INTERVENE

Objective: To determine whether the use of individualized patient care plans and multidisciplinary case management would decrease ED utiliza tion by frequent ED users. Methods: The authors performed a prospectiv e, randomized clinical trial of the impact of a care plan on ED use by adults with frequent ED visits. Patients with >10 ED visits to a univ ersity hospital in 1993 were identified. Patients were matched for age , sex, and number of visits and then randomized into 2 groups. The con trol group received standard emergency care, The treatment group was m anaged by a multidisciplinary team and treated in the ED according to individualized care plans, ED use was tracked at the university hospit al and at the other 5 community hospitals in the city. Results: Of the 70 enrolled patients, 25 of 37 control patients and 27 of 33 treatmen t patients made visits to the university hospital during the 1-year st udy period. Only those patients with follow-up visits were included in the data analysis. Patients remaining in the control group made 247 t otal visits (range 1-65) to the university hospital and 179 total visi ts (range 0-38) to the community hospitals during the study period, Pa tients in the treatment group made 320 total visits (range 1-72) to th e university hospital and 254 total visits (range 0-135) to the commun ity hospitals during the study period. There was no significant differ ence in the median number of visits made to either the university hosp ital or the community hospitals by the patients in the control group a nd those in the treatment group. Conclusions: The use of individualize d care plans and case management did not significantly decrease ED uti lization by frequent ED users, However, the impact of individualized c are plans and case management on other quality-of-care measures (e.g., patient satisfaction, ED length of stay, hospitalizations, primary ca re visits, and health care costs) remains to be determined.