Bodenmann Patrick, Velonaki Venetia-Sofia, Ruggeri Ornella, Hugli Olivier, Burnand Bernard, Wasserfallen Jean-Blaise, Moschetti Karine, Iglesias Katia, Baggio Stéphanie, Daeppen Jean-Bernard
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne CH-1015, Switzerland.
BMC Health Serv Res. 2014 Jun 17;14:264. doi: 10.1186/1472-6963-14-264.
We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients' emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers.
METHODS/DESIGN: We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient's allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient's satisfaction will also be collected at the baseline and 12 months later.
Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care.
ClinicalTrials.gov Identifier: NCT01934322.
我们设计了一项随机对照试验，以评估基于病例管理护理对频繁使用急诊科患者的干预措施的有效性和效率。该干预措施的目的是减少此类患者对急诊科的使用，改善他们的生活质量，并降低因频繁使用而产生的成本。该干预措施由综合病例管理护理和标准急诊护理相结合组成。它采用一种临床病例管理模式，这种模式由患者确定、以患者为导向，并旨在提供高强度服务。它提供一系列基于医院和社区的患者服务，包括临床评估、外展转诊以及与其他服务提供者的协调和沟通。
方法/设计：我们的目标是在研究的第一年招募250名到瑞士洛桑大学医院急诊科就诊的患者。符合条件的患者在过去12个月内到急诊科就诊过5次或更多次。参与者随机分配到干预组或对照组将通过计算机生成并进行隐藏。统计人员和每位患者都将对患者的分组情况不知情。干预组（N = 125）的参与者除了接受标准急诊护理外，在住院期间以及出院后1个月、3个月和5个月，将在其住所、医院或门诊护理机构接受团队的病例管理，次数为1次（门诊护理）至3次（住院治疗）。在提供的会诊之间，患者将有机会随时联系病例管理团队。对照组（N = 125）的参与者将仅接受标准急诊护理。将在基线以及2个月、5.5个月、9个月和12个月后收集数据，包括：急诊科就诊次数、生活质量（欧洲生活质量量表和世界卫生组织生活质量量表）、卫生服务使用情况以及相关成本。关于歧视感受和患者满意度的数据也将在基线和12个月后收集。
我们的研究将有助于澄清关于基于病例管理护理的干预措施的积极结果（急诊科就诊次数、生活质量、效率和成本效益）方面的知识空白。
ClinicalTrials.gov标识符：NCT01934322。
