Evaluation of a Case-management Program for Frequent Emergency Department Users

NCT07635680 | Completed

• 1 other identifier: 2022_PI_095
• Study Type: interventional
• Target: 153
• Locations: 1 country
• Sites: 1

Brief Summary

The DAUM case-management program for frequent users (FUs) of emergency department was developed to improve FUs identification and management. FUs were eligible if they had four ED visits or more in the previous year, and attended the ED between November, 2022 and October, 2023. Patients were identified in the ED and addressed to the territorial support platform. A personalized health coordination plan which included a care plan (care objectives) and a support plan (social objectives) was co-constructed by the support platform, the patient, their caregiver(s), and their GP. Follow-up assessments at three to six months and at one year evaluated whether individual objectives were achieved. The primary outcomes were participants' mean number of ED visits during their year of participation in the program compared to the previous year, and the incremental cost-effectiveness ratio (ICER), expressed as the cost per ED visit avoided. Secondary outcomes included reach, adoption, implementation, and maintenance indicators.

Conditions

Frequent Users of Emergency Department (FUEDs)

Keywords

frequent users; emergency department; case-management program; RE-AIM; cost-effectiveness

Outcome Measures

Primary Outcomes (2)

• Effectiveness

  Mean number of ED visits among included patients

  Before-after comparison between the mean number of ED visits during the year of program participation and the mean number of ED visits in the preceding year

• Cost-effectiveness

  Incremental cost-effectiveness ratio in cost per ED visit avoided

  One year

Secondary Outcomes (25)

• Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients

  One year

• Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed

  One year

• Indicator Reach 3 - Percentage of patients who effectively participated in the program

  One year

• Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians

  One year

• Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit

  One year

Study Arms (1)

Case-management program

EXPERIMENTAL

Patients included in the case-management program

Behavioral: Case-management program

Interventions

Case-management program BEHAVIORAL

FUs patients were identified by the admission nurse through an alert generated by the ED information system. The ED physician explained the DAUM program to the patient and notified the Territorial Support Platform (TSP). The TSP team contacted the patient and his/her GP to present the DAUM program, obtain their agreement to participate and collect additional information. Once the patient included in the DAUM program, a Personalized Health Coordination Plan (PHCP) was co-constructed by the TSP team, in collaboration with the patient, hi/her GP, and other caregiver(s). The PHCP is divided into a care plan (with care objectives) and a support plan (with social obectives). Once the objectives of the care and support plans were identified for a patient, specific actions and timeframes were established for each objective. Follow-up assessments were conducted at three to six months from the inclusion and at one year.

Case-management program

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• adults
• who visited the ED of Nancy University Hospital between November 7th, 2022, and October 6th, 2023
• with at least four ED visits during the preceding year
• residing in Nancy or the surrounding urban areas

You may not qualify if:

• homeless patients
• patient refusal to participate
• patient's GP refusal to participate

Sponsors & Collaborators

• Central Hospital, Nancy, France: lead
• agence régionale de santé Grand Est: collaborator
• Dispositif d'appui à la coordination de Meurthe-et-Moselle: collaborator

Study Sites (1)

Nancy University Hospital

Nancy, France

Location

Related Publications (6)

• Gabet M, Armoon B, Meng X, Fleury MJ. Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review. Am J Emerg Med. 2023 Dec;74:1-8. doi: 10.1016/j.ajem.2023.09.008. Epub 2023 Sep 9.

  PMID: 37717467 BACKGROUND

• Reinhart L, Dechartres A, Beaune S, Bonnet-Zamponi D, Chauvin A, Yordanov Y. Clinical and sociodemographic factors associated with frequent use of emergency services by persons of advanced age in Paris: a nested case-control study. Emergencias. 2025 Feb;37(1):7-14. doi: 10.55633/s3me/114.2024. English, Spanish.

  PMID: 39898941 BACKGROUND

• Calastri C, Buckell J, Crastes Dit Sourd R. Avoidable visits to UK emergency departments from the patient perspective: A recursive bivariate probit approach. Health Policy. 2025 Apr;154:105265. doi: 10.1016/j.healthpol.2025.105265. Epub 2025 Feb 12.

  PMID: 39987851 BACKGROUND

• Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthcare (Basel). 2022 Aug 25;10(9):1625. doi: 10.3390/healthcare10091625.

  PMID: 36141237 BACKGROUND

• Darraj A, Hudays A, Hazazi A, Hobani A, Alghamdi A. The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review. Healthcare (Basel). 2023 Jan 29;11(3):385. doi: 10.3390/healthcare11030385.

  PMID: 36766963 BACKGROUND

• Ohaiba MM, Anamazobi EG, Okobi OE, Aguda K, Chukwu VU. Trends and Patterns in Emergency Department Visits: A Comprehensive Analysis of Adult Data From the National Center for Health Statistics (NCHS) Database. Cureus. 2024 Aug 3;16(8):e66059. doi: 10.7759/cureus.66059. eCollection 2024 Aug.

  PMID: 39229409 BACKGROUND

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Head of Emergency Department

Study Record Dates

• First Submitted: May 19, 2026
• First Posted: June 9, 2026
• Study Start: November 7, 2022
• Primary Completion: October 31, 2024
• Study Completion: October 31, 2024
• Last Updated: June 9, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

FR (1)