title: A telephone-based case-management intervention reduces healthcare utilization for frequent emergency department visitors.
abstract: BACKGROUND
  A small group of frequent visitors to emergency departments accounts for a disproportional large number of total emergency department visits. Previous interventions in this population have shown mixed results.
  
  
  OBJECTIVE
  To determine whether a nurse-managed telephone-based case-management intervention can reduce healthcare utilization and improve self-assessed health status in frequent emergency department users.
  
  
  METHODS
  We carried out a Zelen-design randomized-controlled trial among patients who were identified as frequent emergency department users (≥ 3 visits during the 6 months before inclusion) at the Karolinska University Hospital in Stockholm (Sweden). Patients included in the study (n = 268) were randomized to either the intervention group or the control group and followed for 1 year. Patients who declined to participate or could not be reached were also followed for the study outcome.
  
  
  RESULTS
  The telephone-based case-management intervention reduced the total number of outpatient visits (relative risk 0.80; 95% confidence interval 0.75-0.84), the number of emergency department visits (relative risk 0.77; 95% confidence interval 0.69-0.86), the number of days patients were admitted to hospitals as well as the total healthcare costs for hospital admissions. There was no difference in mortality or other identified adverse outcomes between the intervention and the control groups. Patient self-assessed health status improved for the patients who received the case-management intervention.
  
  
  CONCLUSIONS
  Our results indicate that the nurse-managed telephone-based case-management intervention represents a possible strategy to improve care for frequent emergency department users as well as decrease outpatient visits, admission days and healthcare costs.
authors.affiliation: Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Reinius
authors.forename: Magnus
authors.initials: M
authors.lastname: Johansson
authors.forename: Ann
authors.initials: A
authors.lastname: Fjellner
authors.forename: Joachim
authors.initials: J
authors.lastname: Werr
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ohlén
authors.forename: Gustaf
authors.initials: G
authors.lastname: Edgren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006300:Health Services Misuse / Q000517:prevention & control*; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013548:Sweden; D055817:Telenursing; D016896:Treatment Outcome