Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
Eur J Emerg Med. 2013 Oct;20(5):327-34. doi: 10.1097/MEJ.0b013e328358bf5a.
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.
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.
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.
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.
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.
一小部分经常光顾急诊部的患者占据了急诊部总就诊人数的不成比例的大部分。以前针对这一人群的干预措施效果参差不齐。
确定护士管理的基于电话的病例管理干预措施是否可以减少高频急诊患者的医疗保健利用，并改善其自我评估的健康状况。
我们在斯德哥尔摩卡罗林斯卡大学医院（瑞典）进行了一项 Zelen 设计的随机对照试验，纳入了被确定为高频急诊患者（在纳入前 6 个月内就诊≥3 次）的患者。研究纳入的患者（n=268）被随机分为干预组或对照组，并随访 1 年。拒绝参与或无法联系到的患者也进行了研究结果的随访。
基于电话的病例管理干预措施减少了门诊就诊次数（相对风险 0.80；95%置信区间 0.75-0.84）、急诊就诊次数（相对风险 0.77；95%置信区间 0.69-0.86）、患者住院天数以及住院总医疗费用。干预组和对照组在死亡率或其他确定的不良结局方面没有差异。接受病例管理干预的患者自我评估的健康状况有所改善。
我们的结果表明，护士管理的基于电话的病例管理干预措施可能是改善高频急诊患者护理以及减少门诊就诊、住院天数和医疗保健费用的一种策略。
