title: The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department.
abstract: OBJECTIVE
  To evaluate the effects of multidisciplinary case management (CM) on emergency department (ED) utilisation and psychosocial variables for frequent attenders at the ED.
  
  
  METHODS
  Retrospective cohort analysis, with the study population as historical controls and data analysed 12 months before and after CM intervention in the period 1 January 2000 - 31 December 2004. Subgroup analyses were performed according to primary problem categories: general medical, drug and alcohol, and psychosocial.
  
  
  METHODS
  Inner urban tertiary hospital ED.
  
  
  METHODS
  Frequent ED attenders who received CM.
  
  
  METHODS
  ED attendances: length of stay, triage category, ambulance transport, disposition, attendances at the only two EDs nearby. Psychosocial factors: housing status, drug and alcohol use, and primary and community care engagement.
  
  
  RESULTS
  60 CM patients attended the ED on 1387 occasions. Total attendances increased after CM for the whole group (610 v 777, P = 0.055). Mean average length of stay (minutes) of the total study population and each subgroup was unaffected by CM (297 v 300, P = 0.8). Admissions for ED overnight observation increased as a result of CM (P = 0.025). CM increased scores for housing stability (P = 0.007), primary care linkage (P = 0.003), and community care engagement (P < 0.001) for the whole group and variously within subgroups. Drug and alcohol use was unaffected by CM.
  
  
  CONCLUSIONS
  ED-initiated, multidisciplinary CM appears to increase ED utilisation and have a positive effect on some psychosocial factors for frequent attenders. A trend towards increased ED attendance and utilisation with CM may have implications for policies that seek to divert frequent attenders away from hospitals.
authors.affiliation: St. Vincent's Health, Melbourne, Victoria. Georgina.Phillips@svhm.org.au
authors.forename: Georgina Ann
authors.initials: GA
authors.lastname: Phillips
authors.forename: David S
authors.initials: DS
authors.lastname: Brophy
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: Antony J
authors.initials: AJ
authors.lastname: Chenhall
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dent
mesh_terms: D000328:Adult; D019090:Case Management / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000628:therapy; D014739:Victoria