The effects of clinical case management on hospital service use among ED frequent users

This study examined the impact of case management on hospital service use, hospital costs, homelessness, substance abuse, and psychosocial problems in frequent users of a public urban emergency department (ED). Subjects were 53 patients who used the ED five times or more in 12 months. Utilization, c ost, and psychosocial variables were compared 12 months before and after th e intervention. The median number of ED visits decreased from 15 to 9 (P < .01), median ED costs decreased from $4,124 to $2,195 (P < .01) and median medical inpatient costs decreased from $8,330 to $2,786 (P < .01). Homeless ness decreased by -57% (P < .01), alcohol use by -22% (P = .05) and drug us e by -26% (P = .05). Linkage to primary care increased 74% (P < .01). Fifty -four percent of medically indigent subjects obtained Medicaid (P < .01). T here was a net cost savings, with each dollar invested in the program yield ing a $1.44 reduction in hospital costs. Thus, case management appears to b e a cost-effective means of decreasing acute hospital service use and psych osocial problems among frequent ED users. Copyright (C) 2000 by W.B. Saunde rs Company.