Operation care: a pilot case management intervention for frequent emergency medical system users.
OBJECTIVE
This study aims to determine if a prehospital case management intervention reduces transport and nontransport emergency medical system (EMS) responses to frequent EMS users.


METHODS
The 25 most frequent EMS users in a major metropolitan area were identified, and 10 were enrolled in the intervention. These patients received linkage to psychosocial and medical resources through weekly case management visits for 5 to 12 weeks between May and August 2008. Main outcome measures were the number of transport and nontransport EMS responses to patients during the intervention as compared with predicted EMS responses based on each patient's previous year's EMS use. Transport data were available for all patients, but nontransport data were unavailable for 1 patient who was homeless and 6 patients living in apartment buildings. Secondary outcome measures included cost savings to the entire health care system and the Baltimore City Fire Department.


RESULTS
Transport responses decreased 32% over the 76 predicted transport responses during the intervention, and nontransport responses decreased 79% over the 24 predicted nontransport responses during the intervention. Including the dedicated case manager's salary, this represented a cost savings to the entire health care system and to the Baltimore City Fire Department of $14 461 and $6311, respectively, over 12 weeks.


CONCLUSIONS
Prehospital case management may reduce EMS use in high-frequency EMS users and create significant cost savings to municipalities and the health care system. Additional large-scale studies are needed to validate these findings.
Department of Pediatrics, Division of Quality and Safety, Johns Hopkins School of Medicine, Baltimore, MD, USA. mrinke1@jhmi.edu
Michael L
ML
Rinke
Elisabeth
E
Dietrich
Traci
T
Kodeck
Kathleen
K
Westcoat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D019090:Case Management; D017046:Cost Savings; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014187:Transportation of Patients / Q000191:economics / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data