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Case management intervention of high users of the emergency department of a Portuguese hospital: a before-after design analysis.
Gonçalves, Simão; von Hafe, Francisco; Martins, Flávio; Menino, Carla; Guimarães, Maria José; Mesquita, Andreia; Sampaio, Susana; Londral, Ana Rita.
Afiliación
  • Gonçalves S; Value for Health CoLAB, NOVA Medical School, Lisbon, Portugal.
  • von Hafe F; Nova School of Science and Technology, Nova University of Lisbon, Lisbon, Portugal.
  • Martins F; Value for Health CoLAB, NOVA Medical School, Lisbon, Portugal. francisco.vonhafe@vohcolab.org.
  • Menino C; CHRC, Comprehensive Health Research Centre, NOVA Medical School, UNL, 1099-085, Lisbon, Portugal. francisco.vonhafe@vohcolab.org.
  • Guimarães MJ; Value for Health CoLAB, NOVA Medical School, Lisbon, Portugal.
  • Mesquita A; Nova LINCS, Nova School of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal.
  • Sampaio S; Hospital Garcia de Orta, EPE, Almada, Portugal.
  • Londral AR; Unidade de Saúde Familiar Cova da Piedade, Almada, Portugal.
BMC Emerg Med ; 22(1): 159, 2022 09 13.
Article en En | MEDLINE | ID: mdl-36100864
BACKGROUND: Emergency department (ED) High users (HU), defined as having more than ten visits to the ED per year, are a small group of patients that use a significant proportion of ED resources. The High Users Resolution Group (GRHU) identifies and provides care to HU to improve their health conditions and reduce the frequency of ED visits by delivering patient-centered case management integrated care. The main objective of this study was to measure the impact of the GRHU intervention in reducing ED visits, outpatient appointments, and hospitalizations. As secondary objectives, we aimed to compare the GRHU intervention costs against its potential savings or additional costs. Finally, we intend to study the impact of this intervention across different groups of patients. METHODS: We studied the changes triggered by the GRHU program in a retrospective, non-controlled before-after analysis of patients' hospital utilization data on 6 and 12-month windows from the first appointment. RESULTS: A total of 238 ED HU were intervened. A sample of 152 and 88 patients was analyzed during the 6 and 12-month window, respectively. On the 12-month window, GRHU intervention was associated with a statistically significant reduction of 51% in ED visits and hospitalizations and a non-statistically significant increase in the total number of outpatient appointments. Overall costs were reduced by 43.56%. We estimated the intervention costs to be €79,935.34. The net cost saving was €104,305.25. The program's Return on Investment (ROI) was estimated to be €2.3. CONCLUSION: Patient-centered case management for ED HU seems to effectively reduce ED visits and hospitalizations, leading to better use of resources.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Manejo de Caso / Servicio de Urgencia en Hospital Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: BMC Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2022 Tipo del documento: Article País de afiliación: Portugal Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Manejo de Caso / Servicio de Urgencia en Hospital Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: Europa Idioma: En Revista: BMC Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA Año: 2022 Tipo del documento: Article País de afiliación: Portugal Pais de publicación: Reino Unido