The Efficacy of Case Management on Emergency Department Frequent Users: An Eight-Year Observational Study.
BACKGROUND
Case management is an effective short-term means to reduce Emergency Department (ED) visits in frequent users of the ED.


OBJECTIVE
Our study aimed to assess the long-term efficacy of intensive case management in frequent users of the ED.


METHODS
This was an observational study of ED usage conducted at a community hospital that has an ED case management program in which frequent users of the ED are enrolled and provided with intensive care management to reduce ED use.


RESULTS
We identified 199 patients that were enrolled for 6 or more years. Patients averaged 16 visits per person per year in the year prior to enrollment. Patients averaged the following number of visits per person per year after enrollment: year 1 (7.1), year 2 (4.1), year 3 (3.1), year 4 (3.3), year 5 (3.1), year 6 (2.0), year 7 (2.1), and year 8 (1.9), all statistically significant compared to the year prior to enrollment. Twenty-nine patients, despite case management, continued their frequent use, and required a revision to their plan of care. Five patients required a second revision to their plan of care secondary to recurrent ED usage. Persistent use despite case management was primarily due to prescription medication misuse and chronic pain.


CONCLUSIONS
Case management of ED frequent users seems to be an effective means to reduce ED usage in both the short and long term. Patients with prescription drug misuse or chronic pain may continue to demonstrate frequent use despite case management, and may require revisions to their plan of care.
Division of Emergency Medicine, Community Hospital of the Monterey Peninsula, Monterey, California.
Casey A
CA
Grover
Division of Emergency Medicine, Community Hospital of the Monterey Peninsula, Monterey, California.
Elizabeth
E
Crawford
Division of Emergency Medicine, Community Hospital of the Monterey Peninsula, Monterey, California.
Reb J H
RJ
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D000328:Adult; D000368:Aged; D019090:Case Management / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000639:trends*
case management; emergency department; frequent users