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Kirvalidze M, Boström AM, Liljas A, Doheny M, Hendry A, McCormack B, Fratiglioni L, Ali S, Ebrahimi Z, Elmståhl S, Eriksdotter M, Gläske P, Gustafsson LK, Rundgren ÅH, Hvitfeldt H, Lennartsson C, Hammar LM, Nilsson GH, Nilsson P, Öhlén J, Sandgren A, Söderman A, Swedberg K, Vackerberg N, Vetrano DL, Wijk H, Agerholm J, Calderón-Larrañaga A. Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective. J Intern Med 2024; 295:804-824. [PMID: 38664991 DOI: 10.1111/joim.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.
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Affiliation(s)
- Mariam Kirvalidze
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Ann Liljas
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Megan Doheny
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Anne Hendry
- International Foundation for Integrated Care (IFIC), Glasgow, Scotland, UK
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, Scotland, UK
| | - Brendan McCormack
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Sulin Ali
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden
| | - Maria Eriksdotter
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Pascal Gläske
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Lena-Karin Gustafsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | | | | | - Carin Lennartsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden
| | - Lena Marmstål Hammar
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Peter Nilsson
- Myndigheten för vård- och omsorgsanalys, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
- Palliative Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicoline Vackerberg
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Janne Agerholm
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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Rasmussen MK, Benthien KS, Nielsen CP, Rasmussen K, Grønkjær M, Toft U, Kidholm K. Cost-effectiveness of proactive health support-telephone-based self-management support compared with standard care for persons at risk of hospital admission. Age Ageing 2024; 53:afae036. [PMID: 38476101 DOI: 10.1093/ageing/afae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND A small share of patients account for a large proportion of costs to the healthcare system in Denmark as in many Western countries. A telephone-based self-management support, proactive health support (PaHS), was suggested for prevention of hospitalisations for persons at risk of hospital admission. These persons have chronic diseases, unplanned hospitalisations and age ≥ 65 years. However, evidence is limited on whether this type of intervention is cost-effective. AIM The aim of this study was to assess the incremental cost-utility ratio (ICER) of PaHS, compared with standard care. METHODS The economic evaluation was nested within a randomised controlled trial, and was based on a health system perspective, with follow-up and time horizon of 12 months. We measured incremental costs per quality-adjusted life years (QALY) gained. Total average costs per patient included PaHS programme costs, and costs in hospitals, primary care and municipalities. We analysed differences by generalised linear models with Gamma distribution for costs and mixed models for QALY. RESULTS We analysed data on 6,139 patients, where 3,041 received PaHS and 3,098 received usual care. We found no difference in healthcare costs, and programme costs were on average €1,762 per patient, providing incremental costs of €2,075. Incremental effects on QALY were 0.007, resulting in an ICER of €296,389 per QALY gained. CONCLUSION We found no evidence of PaHS being cost-effective in this study, but the results will be used to identify new ways to organise similar interventions and identify patients with the objective to reduce health system costs per patient.
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Affiliation(s)
- Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Kirstine Skov Benthien
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Palliative Care Unit, Copenhagen University Hospital, Hvidovre, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM-Social & Health Services and Labour Market, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Knud Rasmussen
- Department of Data and Development Support, Region Zealand, Sorø, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Toft
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Bull LM, Arendarczyk B, Reis S, Nguyen A, Werr J, Lovegrove-Bacon T, Stone M, Sherlaw-Johnson C. Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial. Emerg Med J 2023; 41:51-59. [PMID: 37827821 DOI: 10.1136/emermed-2022-212908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 09/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Health coaching services could help to reduce emergency healthcare utilisation for patients targeted proactively by a clinical prediction model (CPM) predicting patient likelihood of future hospitalisations. Such interventions are designed to empower patients to confidently manage their own health and effectively utilise wider resources. Using CPMs to identify patients, rather than prespecified criteria, accommodates for the dynamic hospital user population and for sufficient time to provide preventative support. However, it is unclear how this care model would negatively impact survival. METHODS Emergency Department (ED) attenders and hospital inpatients between 2015 and 2019 were automatically screened for their risk of hospitalisation within 6 months of discharge using a locally trained CPM on routine data. Those considered at risk and screened as suitable for the intervention were contacted for consent and randomised to one-to-one telephone health coaching for 4-6 months, led by registered health professionals, or routine care with no contact after randomisation. The intervention involved motivational guidance, support for self-care, health education, and coordination of social and medical services. Co-primary outcomes were emergency hospitalisation and ED attendances, which will be reported separately. Mortality at 24 months was a safety endpoint. RESULTS Analysis among 1688 consented participants (35% invitation rate from the CPM, median age 75 years, 52% female, 1139 intervention, 549 control) suggested no significant difference in overall mortality between treatment groups (HR (95% CI): 0.82 (0.62, 1.08), pr(HR<1=0.92), but did suggest a significantly lower mortality in men aged >75 years (HR (95% CI): 0.57 (0.37, 0.84), number needed to treat=8). Excluding one site unable to adopt a CPM indicated stronger impact for this patient subgroup (HR (95% CI): 0.45 (0.26, 0.76)). CONCLUSIONS Early mortality in men aged >75 years may be reduced by supporting individuals at risk of unplanned hospitalisation with a clear outreach, out-of-hospital nurse-led, telephone-based coaching care model.
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Affiliation(s)
- Lucy M Bull
- Modelling and Insights, Health Navigator, London, UK
| | | | - Sara Reis
- Modelling and Insights, Health Navigator, London, UK
| | - An Nguyen
- Data Science and Strategy, Health Navigator, London, UK
| | | | - Thomas Lovegrove-Bacon
- Strategic Development, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Mark Stone
- North Place Clinical Lead, Staffordshire and Stoke ICB, Stafford, UK
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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Richart-Martínez M. Factors associated with frequent users in hospital paediatric emergency departments: A single centre study in Spain. Int Emerg Nurs 2023; 70:101344. [PMID: 37714055 DOI: 10.1016/j.ienj.2023.101344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Over the last decade, the demand for hospital paediatric emergency departments (PEDs) has been on the rise. Studies have been carried out in adults, but in paediatrics, and in Spain, they are few and far between. In order to develop interventions to alleviate this problem, it is necessary to understand the factors that predispose people to use these services. OBJECTIVE The main objective of this study was to identify the factors associated with frequent users of PEDs in Spain. METHODS A descriptive, cross-sectional study conducted between September 2021 and December 2022 in the PED of a referral hospital in Spain. RESULTS There were 530 participants, 12.07% of whom were frequent users. There was an indirect association between frequent use and having a secondary level of education (OR = 0.282, p = 0.002). The factors which were directly associated included: perceived urgency (OR = 10.209, p = 0.002) and the perception that PEDs provide better care than primary care (PC) (OR = 2.664, p = 0.044). CONCLUSIONS The percentage of frequent users is comparable with international levels. As a strategy to reduce the frequency of visits, health interventions are needed to ensure that parents know how to correctly interpret their children's symptoms and are well informed about the recommended flow of care.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain; GREIACC research group, La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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5
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Seidenfeld J, Ramos K, Bruening RA, Sperber NR, Stechuchak KM, Hastings SN. Patient experiences of a care transition intervention for Veterans to reduce emergency department visits. Acad Emerg Med 2023; 30:388-397. [PMID: 36630213 DOI: 10.1111/acem.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Care transition interventions (CTIs) are used to improve outcomes after an emergency department (ED) visit. A recent randomized controlled trial of a Veterans Health Administration (VHA) CTI titled Discharge Information and Support for Patients receiving Outpatient care in the ED (DISPO ED) demonstrated no difference in repeat ED visits. However, changes in health care utilization are not the only measures of a CTI worth evaluation, and there is interest in using patient-centered outcomes to assess CTIs as well. To inform future CTI design and outcome measure selection, the study aims were to understand how patients experienced the CTI and what elements they valued. METHODS This was a qualitative study of participants randomized to the intervention arm of the DISPO ED trial using semistructured interviews. The interview guide included questions about clinical health and other issues addressed by the study nurse, the most and least helpful aspects of the intervention, and impacts of the intervention on their perceptions of self-management. Interviews were analyzed using directed content analysis. RESULTS Our sample comprised 24 participants, with average age of 61 years, 58% male, and 50% Black or African American. We identified six major themes related to (1) experiences during the intervention and (2) elements they valued. Patients reported clinical health coaching recommendations covering a wide range of topics as well as care coordination actions such as appointment scheduling. Valuable elements of the intervention highlighted personal characteristics of the study nurse that promoted a sense of interpersonal connection and empathy in their interactions. CONCLUSIONS Intervention users described assistance with care coordination as well as clinical concerns. We identified aspects that were highly valued by the participants, such as interpersonal support and empathy from the interventionist. These findings suggest the need for more comprehensive nonutilization outcome measures for CTIs to capture the patient's perspective.
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Affiliation(s)
- Justine Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Emergency Medicine, Durham VA Health Care System, Durham, North Carolina, USA.,Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Ramos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
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Benthien KS, Rasmussen K, Nielsen CP, Kidholm K, Grønkjær M, Toft U. Proactive Health Support: a randomised controlled trial of telephone-based self-management support for persons at risk of hospital admission. Age Ageing 2022; 51:6749361. [PMID: 36201327 DOI: 10.1093/ageing/afac212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Persons with frequent hospital admissions have a disease burden that may exceed their self-management skills. The evidence base of telephone-based interventions to support self-management is poor with mixed results. The aim of this study is to evaluate the effect of Proactive Health Support (PaHS): telephone-based self-management support for persons with risk of hospitalizations. METHODS This study is a national randomised controlled trial of PaHS versus usual universal tax-funded healthcare. Participants were persons at risk of emergency hospital admissions. The intervention began with a physical start-up session followed by telephone sessions of self-management support. The two co-primary outcomes were Health-Related Quality of Life (HRQoL) (Mental Health Component Summary Score of SF36v2) analysed with mixed models and hospital admissions analysed with Poisson regression at 6 months. Secondary outcomes were at 3- and 12-month follow-up and disease subgroup analyses. RESULTS During the study period, 6,402 persons were randomised (3,190 intervention, 3,212 control). HRQoL was significantly improved at 6 months (Est. 1.4992, P = <0.0001) and at 3 and 12 months on all 10 scales. There was no overall effect on hospital admissions at 6 months with an adjusted estimate of 0.0074 (P = 0.8691). Persons with diabetes had significant improvement of HRQoL and reduced hospital admissions. CONCLUSIONS The PaHS intervention improved HRQoL for all participants and reduced hospital admissions for persons with diabetes only.
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Affiliation(s)
- Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Palliative Care Unit, Copenhagen University Hospital - Hvidovre, Denmark
| | - Knud Rasmussen
- Data and Development Support, Region Zealand, Sorø, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Social & Health Services and Labour Market, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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An observational pilot study: Prevalence and cost of high frequency emergency department users at Örebro University Hospital, Sweden. PLoS One 2022; 17:e0274622. [PMID: 36107928 PMCID: PMC9477344 DOI: 10.1371/journal.pone.0274622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is little research on high frequency emergency department users (HEDU) in Sweden. We aim to determine the prevalence and costs of HEDU compared to non-HEDU at Örebro University Hospital (ÖUH). Additionally, we will determine the factors and outcomes associated with being a HEDU. Methods This was a retrospective, observational cohort study of ED patients presenting to ÖUH, Sweden between 2018–19. Analyses used electronic registry, ambulance, and cost data. The definition for HEDU was ≥4 visits/year. HEDUs were categorized further into Repeat, High and Super HEDU with 4–7, 8–18 and ≥19 visits/year, respectively. We used multivariable logistic regression to determine the adjusted odds ratios for factors and outcomes between HEDU and non-HEDU. Findings Of all ÖUH ED patients, 6.1% were HEDU and accounted for 22.4% of ED visits and associated costs. Compared to the mean cost of non-HEDU, the Repeat, High and Super HEDU were more costly by factors of 4, 8 and 27, respectively. The HEDUs were more likely to be male, self-referred, present with abdominal pain, arrive by ambulance, at night and from the Örebro municipal region. Super HEDU were more likely to be of adult age and assigned lower acuity scores. HEDU were more likely to be directed to the surgical zone, less likely to receive radiologic imaging or achieve a 4-hr time target. In contrast to the Repeat and High HEDU, Super HEDU were less likely to be admitted, but more likely to leave without being seen. Conclusion ÖUH has a HEDU population with associated factors and outcomes. They account for a substantial proportion of ED costs compared to non-HEDU.
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Elston J, Gradinger FP, Streeter AJ, Macey S, Martin S. Effectiveness of a targeted telephone-based case management service on activity in an Emergency Department in the UK: a pragmatic difference-in-differences evaluation. BMC Health Serv Res 2022; 22:1038. [PMID: 35965330 PMCID: PMC9376120 DOI: 10.1186/s12913-022-08415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluates the effectiveness of a targeted telephone-based case management service that aimed to reduce ED attendance amongst frequent attenders, known to disproportionately contribute to demand. Evidence on the effectiveness of these services varies. METHODS A 24-month controlled before-and-after study, following 808 patients (128 cases and 680 controls (41 were non-compliant)) who were offered the service in the first four months of operation within a UK ED department. Patients stratified as high-risk of reattending ED within 6 months by a predictive model were manually screened. Those positively reviewed were offered a non-clinical, nurse-led, telephone-based health coaching, consisting of care planning, coordination and goal setting for up to 9 months. Service effectiveness was estimated using a difference-in-differences (DiD) analysis. Incident rate of ED and Minor Injury Unit (MIU) attendances and average length of stay in intervention recipients and controls over 12 months after receiving their service offer following ED attendance were compared, adjusting for the prior 12-month period, sex and age, to give an incidence rate ratio (IRR). RESULTS Intervention recipients were more likely to be female (63.3% versus 55.4%), younger (mean of 69 years versus 76 years), and have higher levels of ED activity (except for MIU) than controls. Mean rates fell between periods for all outcomes (except for MIU attendance). The Intention-to-Treat analysis indicated non-statistically significant effect of the intervention in reducing all outcomes, except for MIU attendances, with IRRs: ED attendances, 0.856 (95% CI: 0.631, 1.160); ED admissions, 0.871 (95% CI: 0.628, 1.208); length of stay for emergency and elective admissions: 0.844 (95% CI: 0.619, 1.151) and 0.781 (95% CI: 0.420, 1.454). MIU attendance increased with an IRR: 2.638 (95% CI: 1.041, 6.680). CONCLUSIONS Telephone-based health coaching appears to be effective in reducing ED attendances and admissions, with shorter lengths of stay, in intervention recipients over controls. Future studies need to capture outcomes beyond acute activity, and better understand how services like this provide added value.
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Affiliation(s)
- Julian Elston
- Torbay and South Devon NHS Foundation Trust (TSDFT), Torbay, UK. .,Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Felix P Gradinger
- Torbay and South Devon NHS Foundation Trust (TSDFT), Torbay, UK.,Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Adam J Streeter
- Medical Statistics, Faculty of Health, University of Plymouth, Plymouth, UK.,Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Stephen Macey
- Planning and Performance, Torbay and South Devon, NHS Foundation Trust (TSDFT), Torquay, UK
| | - Susan Martin
- Quality Improvement, Torbay and South Devon, NHS Foundation Trust (TSDFT), Torquay, UK
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Cupp JA, Byrne KA, Herbert K, Roth PJ. Acute Care Utilization After Recovery Coaching Linkage During Substance-Related Inpatient Admission: Results of Two Randomized Controlled Trials. J Gen Intern Med 2022; 37:2768-2776. [PMID: 35296984 PMCID: PMC8926086 DOI: 10.1007/s11606-021-07360-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/16/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND For patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization. OBJECTIVE Examine effect of PRCs on acute care utilization. DESIGN Combined results of 2 parallel 1:1 randomized controlled trials. PARTICIPANTS Inpatient adults with substance use disorder INTERVENTIONS: Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) MAIN MEASURES: Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores. KEY RESULTS A total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = -0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = -2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65). CONCLUSIONS PRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use. TRIAL REGISTRATION ClinicalTrials.gov (NCT04098601, NCT04098614).
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Affiliation(s)
| | | | - Kristin Herbert
- University of South Carolina School of Medicine-Greenville, Greenville, USA
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10
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Cohen JN, Nguyen A, Rafiq M, Taylor P. Impact of a case-management intervention for reducing emergency attendance on primary care: randomised control trial. Br J Gen Pract 2022; 72:BJGP.2021.0545. [PMID: 35577585 PMCID: PMC9119815 DOI: 10.3399/bjgp.2021.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The impact on primary care workload of case-management interventions to reduce emergency department (ED) attendances is unknown. AIM To examine the impact of a telephone-based case-management intervention targeting people with high ED attendance on primary care use. DESIGN AND SETTING A single-site data extract from a larger randomised control trial, using the patient-level data from primary care electronic health records (2015-2020), was undertaken. METHOD A total of 363 patients at high risk of ED usage were randomised to receive a 6-month case-management intervention (253 patients) or standard care (110 patients). Poisson regression models were used to calculate monthly rates of primary care use over time for the 2 years post-randomisation, comparing both arms. Usage was subclassified into face-to-face, telephone, letter, and community and secondary care referrals, stratified by patient demographics. RESULTS No significant difference was found in the mean annual rate of primary care events between the intervention and control arms (P = 0.70). Secondary care referrals saw a 26% reduction in the mean annual referral rate (incident rate ratio [IRR] 0.74, 95% confidence interval [CI] = 0.64 to 0.86, P<0.001) and letters sent increased by 6% in the intervention arm compared with the control arm (IRR 1.06, 95% CI = 1.01 to 1.11, P = 0.01). In the case-managed arm, in patients aged ≥80 years there was a 33% increase in primary care usage (IRR 1.33, 95% CI = 1.28 to 1.40, P<0.001); with a corresponding 10% decrease in patients aged <80 years when compared with controls (IRR 0.90, 95% CI = 0.87 to 0.92, P<0.001). CONCLUSION A targeted case-management intervention to reduce ED attendances did not increase overall primary care use. Redistribution of usage is seen among some patient groups, particularly older people, which may have important implications for primary healthcare planning.
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Affiliation(s)
- Jonathan N Cohen
- Institute of Health Informatics, University College London, London
| | | | - Meena Rafiq
- Epidemiology of Cancer and Healthcare Outcomes, Institute of Epidemiology and Health Care, University College London, London
| | - Paul Taylor
- Institute of Health Informatics, University College London, London
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11
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Tyrańska-Fobke A, Robakowska M, Ślęzak D, Pogorzelczyk K, Basiński A. Searching for the Optimal Method of Financing Hospital Emergency Departments-Comparison of Polish and Selected European Solutions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031507. [PMID: 35162526 PMCID: PMC8835359 DOI: 10.3390/ijerph19031507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023]
Abstract
Hospital emergency departments are units of the State Medical Rescue system in Poland, which was established to help people in a state of a health emergency. The aim of this study is to develop an optimal method of financing emergency departments in Poland. The study used Polish data from 2016–2019 on the financing of services at the Clinical Emergency Department of the University Clinical Center in Gdańsk. For benchmarking and mathematical modeling, data for the Czech Republic, Germany and Latvia was used. The results of the analysis shows significant differences, to the disadvantage of Clinical Emergency Department, between the potential contract values in the tested models and the actual amounts of funds transferred by the National Health Fund Pomeranian Voivodeship Branch for the activities of Clinical Emergency Department under the concluded contracts. The introduction of co-payment on the part of patients reporting to the emergency departments with minor ailments that do not require hospitalization generates financial revenues, but does not significantly improve the financial results of the analyzed ward. However, it may be educational for patients in terms of raising their awareness of the correct place to seek assistance in the event of a sudden illness.
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Affiliation(s)
- Anna Tyrańska-Fobke
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence: (A.T.-F.); (D.Ś.)
| | - Marlena Robakowska
- Department of Public Health & Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Daniel Ślęzak
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
- Correspondence: (A.T.-F.); (D.Ś.)
| | | | - Andrzej Basiński
- Department of Medical Rescue, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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12
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Braz PGDCG, Vila VDSC, Neves HCC. Strategies for case management in transitional care in emergency services: scoping review. Rev Bras Enferm 2021; 73Suppl 5:e20190506. [PMID: 33027493 DOI: 10.1590/0034-7167-2019-0506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/14/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to map and synthesize the strategies implemented for case management in transitional care for patients with complex needs in emergency services. METHOD a scoping review conducted under the Joanna Briggs Institute guidance. Twenty-three studies were analyzed, with different methodological designs, on the strategies used in case management involving adult and elderly populations in emergency services. RESULTS the main strategies employed were patient risk stratification screening/identification, care management plan, coordination of care through multidisciplinary activities, support for the transition process, continuous patient monitoring, and follow-up. FINAL CONSIDERATIONS these strategies used structured approaches to care in emergency services to promote support for self-management and effective transitional care for people with complex needs, ensuring comprehensiveness, coordination, and continuity of care.
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13
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Béland S, Dumont-Samson O, Hudon C. Case Management and Telehealth: A Scoping Review. Telemed J E Health 2021; 28:11-23. [PMID: 33847524 DOI: 10.1089/tmj.2021.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Case management (CM) is an intervention adapted to the needs of patients with chronic conditions or complex needs. Factors associated with effectiveness of CM, such as high intervention intensity, can represent challenges to its implementation. Telehealth has the potential to help overcome these challenges, but little work has been done to synthesize available evidence on telehealth CM. The purpose of this scoping review was thus to fill this gap and document which telehealth modalities have been used, summarize perspectives of key users, and discuss evidence on effectiveness of telehealth-delivered CM. Methods: A search in MEDLINE, Scopus, and CINAHL for articles published between January 2005 and January 2021 was done. Studies in which telehealth was used for patient-case manager interaction and conducted in a population with complex health needs and/or chronic conditions were included. Articles selected for full-text review were independently screened by two reviewers. Data extraction was conducted once and validated by a second reviewer. Results: Of 3,108 articles, 22 were retained for data extraction. A narrative synthesis was conducted. Most studies evaluated CM interventions delivered over telephone, yet, literature suggests that face-to-face contact is essential to CM success. Results also indicate that telehealth CM is acceptable and effective, associated with better utilization of health services and favorable clinical outcomes. Conclusions: Lack of research evaluating telehealth CM delivered using modalities other than telephone. Further research should evaluate CM interventions that integrate platforms enabling visual information exchange.
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Affiliation(s)
- Sophie Béland
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Olivier Dumont-Samson
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada
| | - Catherine Hudon
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Canada
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14
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Optimizing emergency department care transitions to outpatient settings: A systematic review and meta-analysis. Am J Emerg Med 2020; 38:2667-2680. [DOI: 10.1016/j.ajem.2020.07.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
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15
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Winther S, Fredens M, Hansen MB, Benthien KS, Nielsen CP, Grønkjær M. Proactive Health Support: Exploring Face-to-Face Start-Up Sessions Between Participants and Registered Nurses at the Onset of Telephone-Based Self-Management Support. Glob Qual Nurs Res 2020; 7:2333393620930026. [PMID: 32656297 PMCID: PMC7328475 DOI: 10.1177/2333393620930026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 12/04/2022] Open
Abstract
Proactive Health Support (PaHS) is a large-scale intervention in Denmark
carried out by registered nurses (RNs) who provide self-management
support to people at risk of hospital admission to enhance their
health, coping, and quality of life. PaHS is initiated with a
face-to-face session followed by telephone conversations. We aimed to
explore the start-up sessions, including if and how the relationship
between participants and RNs developed at the onset of PaHS. We used
an ethnographic design including observations and informal interviews.
Data were analyzed using a phenomenological–hermeneutical approach.
The study showed that contexts such as hospitals and RNs legitimized
the intervention. Face-to-face communication contributed to
credibility, just as the same RN throughout the intervention ensured
continuity. We conclude that start-up sessions before telephone-based
self-management support enable a trust-based relationship between
participants and RNs. Continuous contact with the same RNs throughout
the session promoted participation in the intervention.
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Affiliation(s)
| | - Mia Fredens
- DEFACTUM, Social & Health Services and Labor Market, Aarhus, Denmark
| | | | | | | | - Mette Grønkjær
- Aalborg University Hospital, Aalborg, Denmark.,Aalborg University, Aalborg, Denmark
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16
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Fredens M, Terkildsen MD, Bollerup S, Albæk J, Nissen NK, Winther S, Grønkjær M, Rasmussen MK, Benthien KS, Toft U, Hjarnaa L, Rasmussen K, Nielsen CP. The national implementation of 'Proactive Health Support' in Denmark since 2017: Expectations and challenges for the telephone-based self-management program. Health Policy 2020; 124:674-678. [PMID: 32507526 DOI: 10.1016/j.healthpol.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/06/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022]
Abstract
In Denmark, as in many other Western countries, a small group of people are major hospital users and account for a large proportion of health care spending. Proactive Health Support (PaHS) is the first national Danish program that aims to reduce health care consumption targeting people at risk of becoming major users of health services. PaHS was part of the government's The sooner-the better national health policy, which includes a focus on policy programs targeting the weakest and most complex chronic patients at risk of high health care consumption. PaHS is a telephone-based self-management support program that uses a prediction model to identify people at high risk of acute hospital admissions. Reducing preventable hospital admissions and enhancing quality of life are central policy goals. The Danish policy was inspired by a Swedish policy program, and PaHS has been implemented based on policy transfer with political expectations that the Swedish results can be replicated in Denmark. The effects of PaHS are currently under study, and time will show whether expectations can be met. This paper discusses institutional conditions and expectations related to replicating a policy program and its outcomes. In addition, it highlights implementation issues that may affect the success of the policy program.
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Affiliation(s)
- Mia Fredens
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark.
| | | | - Stina Bollerup
- DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark
| | - Jens Albæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | | | - Susanne Winther
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technologies, Odense University Hospital, Denmark
| | - Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Louise Hjarnaa
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Knud Rasmussen
- Production, Research and Innovation, Region Zealand, Sorø, Denmark
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17
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Danish A, Chouinard MC, Aubrey-Bassler K, Burge F, Doucet S, Ramsden VR, Bisson M, Cassidy M, Condran B, Lambert M, Penney C, Sabourin V, Warren M, Hudon C. Protocol for a mixed-method analysis of implementation of case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs. BMJ Open 2020; 10:e038241. [PMID: 32487584 PMCID: PMC7265033 DOI: 10.1136/bmjopen-2020-038241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Case management (CM) in a primary care setting is a promising approach to integrating and improving healthcare services and outcomes for patients with chronic conditions and complex care needs who frequently use healthcare services. Despite evidence supporting CM and interest in implementing it in Canada, little is known about how to do this. This research aims to identify the barriers and facilitators to the implementation of a CM intervention in different primary care contexts (objective 1) and to explain the influence of the clinical context on the degree of implementation (objective 2) and on the outcomes of the intervention (objective 3). METHODS AND ANALYSIS A multiple-case embedded mixed-methods study will be conducted on CM implemented in ten primary care clinics across five Canadian provinces. Each clinic will represent a subunit of analysis, detailed through a case history. Cases will be compared and contrasted using multiple analytical approaches. Qualitative data (objectives 1 and 2) from individual semistructured interviews (n=130), focus group discussions (n=20) and participant observation of each clinic (36 hours) will be compared and integrated with quantitative (objective 3) clinical data on services use (n=300) and patient questionnaires (n=300). An evaluation of intervention fidelity will be integrated into the data analysis. ETHICS AND DISSEMINATION This project received approval from the CIUSSS de l'Estrie - CHUS Research Ethic Board (project number MP-31-2019-2830). Results will provide the opportunity to refine the CM intervention and to facilitate effective evaluation, replication and scale-up. This research provides knowledge on how to resp ond to the needs of individuals with chronic conditions and complex care needs in a cost-effective way that improves patient-reported outcomes and healthcare use, while ensuring care team well-being. Dissemination of results is planned and executed based on the needs of various stakeholders involved in the research.
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Affiliation(s)
- Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Monique Cassidy
- Department of Nursing and Health Sciences, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Brian Condran
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Quebec, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Memorial University, St-John's, Newfoundland and Labrador, Canada
| | | | - Mike Warren
- NL-SPOR Suppport Unit, St-John's, Newfoundland and Labrador, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre hospitalier universitaire de Sherbrooke Research Centre, Sherbrooke, Québec, Canada
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18
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Benthien KS, Rasmussen K, Nielsen CP, Hjarnaa L, Rasmussen MK, Kidholm K, Nielsen BK, Nissen NK, Fredens M, Winther S, Grønkjær M, Toft U. Proactive health support (PaHS) - telephone-based self-management support for persons at risk of hospital admission: Study protocol for a randomized controlled trial. Contemp Clin Trials 2020; 93:106004. [PMID: 32320846 DOI: 10.1016/j.cct.2020.106004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND A small proportion of patients account for most of the healthcare costs. Previous studies of supportive interventions have several methodological limitations and results are mixed. This article describes the protocol for Proactive Health Support: a national randomized controlled trial of telephone-based self-management support (ClinicalTrials.gov, NCT03628469). The main aim of the intervention is to reduce hospital admissions and improve quality of life at six months. METHODS A sample size of 4400 is needed and individuals with the highest risk of hospital admission in Denmark are invited by electronic communication and telephone to participate in a 1:1 randomized controlled trial. The intervention group receives one face-to-face start-up session followed by telephone sessions about individual goals regarding participants' knowledge, coping and need of healthcare. Quality of life was assessed with the mental health composite score of the SF-36v2 questionnaire. Primary analyses are done using the intention-to-treat principle. DISCUSSION The trial has been approved by The Regional Committee on Health Research Ethics (SJ-677). Intervention nurses do not assume clinical responsibility for the participants and the intervention is an addition to the general healthcare services. The intervention is complex due to challenging skills and behaviors required by nurses, individual tailoring of the intervention, and interacting intervention components. The study therefore includes process evaluation. The research program comprises: 1. Development initiation, 2. Intervention effect, 3. Cost-effectiveness, 4. Organizational implementation, and 5. Participants' experiences. Inclusion to the trial began April 9th, 2018, was completed July 1st, 2019 and follow-up will be completed February 1st, 2020.
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Affiliation(s)
- Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Knud Rasmussen
- Production, Research and Innovation, Region Zealand, Sorø, Denmark.
| | | | - Louise Hjarnaa
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Maja Kjær Rasmussen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.
| | | | | | - Mia Fredens
- DEFACTUM - Social & Health Services and Labour Market, Aarhus, Denmark.
| | - Susanne Winther
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
| | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
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Korczak V, Shanthosh J, Jan S, Dinh M, Lung T. Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review. BMC Emerg Med 2019; 19:83. [PMID: 31888508 PMCID: PMC6937921 DOI: 10.1186/s12873-019-0296-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background Previous systematic reviews have examined the effectiveness of interventions for frequent presenters to the Emergency Department (ED) but not the costs and cost-effectiveness of such interventions. Method A systematic literature review was conducted which screened the following databases: Pubmed, Medline, Embase, Cochrane and Econlit. An inclusion and exclusion criteria were developed following PRISMA guidelines. A narrative review methodology was adopted due to the heterogeneity of the reporting of the costs across the studies. Results One thousand three hundred eighty-nine papers were found and 16 were included in the review. All of the interventions were variations of a case management approach. Apart from one study which had mixed results, all of the papers reported a decrease in ED use and costs. There were no cost effectiveness studies. Conclusion The majority of interventions for frequent presenters to the ED were found to decrease ED use and cost. Future research should be undertaken to examine the cost effectiveness of these interventions.
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Affiliation(s)
- Viola Korczak
- The George Institute for Global Health, UNSW Sydney, Level 5/1 King St Newtown NSW, Sydney, 2042, Australia. .,Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia.
| | - Janani Shanthosh
- The George Institute for Global Health, UNSW Sydney, Level 5/1 King St Newtown NSW, Sydney, 2042, Australia.,The Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, UNSW Sydney, Level 5/1 King St Newtown NSW, Sydney, 2042, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Thomas Lung
- The George Institute for Global Health, UNSW Sydney, Level 5/1 King St Newtown NSW, Sydney, 2042, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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20
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Hudon C, Chouinard MC, Pluye P, El Sherif R, Bush PL, Rihoux B, Poitras ME, Lambert M, Zomahoun HTV, Légaré F. Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review. Ann Fam Med 2019; 17:448-458. [PMID: 31501208 PMCID: PMC7032902 DOI: 10.1370/afm.2419] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1)population: adult frequent users with chronic disease, (2)intervention: CM in a primary care setting with a postintervention evaluation, and (3)primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke, Québec, Canada
| | | | - Pierre Pluye
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Reem El Sherif
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Paula Louise Bush
- Département de Médecine de Famille, Université McGill, Québec, Canada
| | - Benoît Rihoux
- Institut de Sciences Politiques Louvain-Europe (ISPOLE), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie-Eve Poitras
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et Services Sociaux du Saguenay-Lac-Saint-Jean, Québec, Canada
| | | | - France Légaré
- Département de Médecine Familiale et de Médecine d'Urgence, Université Laval, Québec, Canada
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Di Mauro R, Di Silvio V, Bosco P, Laquintana D, Galazzi A. Case management programs in emergency department to reduce frequent user visits: a systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:34-40. [PMID: 31292413 PMCID: PMC6776176 DOI: 10.23750/abm.v90i6-s.8390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Inappropriate visits to the Emergency Department (ED) by frequent users (FU) are a common phenomenon because this service is perceived as a rapid and concrete answer to any health and social issue not necessarily related to urgent matters. Could Case Management (CM) programs be a suitable solution to address the problem? The purpose is to examine how CM programs are implemented to reduce the number of FU visits to the ED. METHODS PubMed, CINAHL and EMBASE were consulted up to December 2018. This review follows PRISMA guidelines for systematic review, as first outcomes were considered the impact of CM interventions on ED utilization, costs and composition of teams. RESULTS Fourteen studies were included and they showed patients with common characteristics but the FU definition wasn't the same. Twelve studies provided a reduction of ED utilization and seven studies a cost reduction. The main tool used is the individual care plan with telephone contact, supportive group therapy, facilitated contacts with healthcare providers and informatics system for immediate identification. The CM team composition is heterogeneous, even if nurses are considered the most used professional figures. CONCLUSIONS In contrast with a standardized method, a customized approach of CM program helps frequent users in finding an appropriate answer to their needs, thus decreasing inappropriate visits to the ED.
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Newman P, McDowell A. Health changing conversations: clinicians' experience of health coaching in the East of England. Future Hosp J 2016; 3:147-151. [PMID: 31098210 DOI: 10.7861/futurehosp.3-2-147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The changing nature of healthcare and the challenge of long-term conditions require a paradigm shift in the mindset and behaviours of professionals. Central to this is the quality of clinician-patient communication, which determines how responsibility is shared. Health coaching training for clinicians provides them with new mindsets, communication skills and behaviour change techniques that transform the clinician--patient relationship and enables patients to become more active participants in their care. This training improves patient experience and health behaviours, provides self-management support and can reduce demand and costs. This article describes the East of England health coaching training programme and provides an overview of the evidence, required competencies and challenges clinicians experience when putting health coaching into practice. It illustrates that health coaching is a mechanism to deliver person-centred care. More must be done to provide clinicians with these much-needed skills especially in the management of long-term conditions.
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Affiliation(s)
- Penny Newman
- Norfolk Community Health and Care NHS Trust, Norwich, UK
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