Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada.
BMC Health Serv Res. 2021 Feb 17;21(1):157. doi: 10.1186/s12913-021-06154-4.
Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population.
This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs.
Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool - 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively.
The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED.
在急诊科（ED）早期识别患有慢性病和复杂健康需求的患者，将能够为他们提供更符合其需求的服务，如病例管理。病例发现工具最终将为此目的支持 ED 团队，并由于避免 ED 就诊和住院治疗，从而降低服务成本。本研究旨在开发和验证一种在 ED 中识别慢性病和复杂健康需求成年患者的简短自我管理病例发现工具。
这是一项前瞻性开发和初步验证研究，涉及魁北克省（加拿大）的四家 ED。在 12 个月内，第三次或更多次就诊 ED 的慢性病成年患者接受了自我管理问卷的调查，该问卷包括社会人口统计学、合并症指数、参考标准 INTERMED 自我评估以及开发病例发现工具的 12 个问题。二变量分析中的显著变量被纳入多变量逻辑回归分析，并应用了向后消除程序。开发了受试者工作特征（ROC）曲线，以确定最合适的阈值分数来识别具有复杂健康需求的患者。
共有 290 名患者参与了这项研究。多变量分析得出了一个六问题工具，即复杂需求病例发现工具-6（CONECT-6），它评估以下变量：低自我感知健康状况；疼痛导致的限制；未满足的需求；高自我感知的复杂性；低收入；以及较差的社会支持。当阈值为两个或更多个阳性答案时，敏感性为 90%，特异性为 66%。阳性和阴性预测值分别为 49%和 75%。
病例发现过程是病例管理有效性的重要特征。本研究提出了第一个用于识别 ED 中患有慢性病和复杂健康需求的成年患者的病例发现工具。
