Research

Research

Leaf In a study funded by the CDC, patients enrolled in Consistent Care showed a 34% decrease in ED visits [1]

Leaf In the same study, Consistent Care enrollees were 80% less likely to receive an opioid prescription [1]

Leaf 2016 cost savings analysis shows average savings of $1659 per patient per year for health plan enrollees [2]

 

Clif Graph

This graph depicts monthly ED visits for a patient cohort of 225 before and after enrollment in case management services with Consistent Care. The average patient had 10 visits in the year prior to enrollment (total of 2240 visits/year), and only 4 in the following year (down to 980 visits/year).

[1] Murphy, S. M. & Neven, D. (2014). Cost-effective: Emergency department care coordination with a regional hospital information system. The Journal of Emergency Medicine, 47(2), 223-231.

[2] Neven, D., Paulozzi, L., Howell, D., McPherson, S., Murphy, S., Grohs, R., Marsh, L., Lederhos, C., & Roll, J. (2016). A randomized controlled trial of a citywide emergency department care coordination program to reduce prescription opioid related ED visits. The Journal of Emergency Medicine, article in press.

Publications

A Randomized Controlled Trial of a Citywide Emergency Department Care Coordination Program to Reduce Prescription Opioid Related Emergency Department Visits.

Neven, D., Paulozzi, L., Howell, D., McPherson, S., Murphy, S., Grohs, R., Marsh, L., Lederhos, C., & Roll, J. (2016). Journal of Emergency Medicine, Article in Press.

Abstract – Background: Increasing prescription overdose deaths have demonstrated the need for safer emergency department (ED) prescribing practices for patients who are frequent ED users. Objectives: We hypothesized that the care of frequent ED users would improve using a citywide care coordination program combined with an ED care coordination information system, as measured by fewer ED visits by and decreased controlled substance prescribing to these patients. Methods: We conducted a multisite randomized controlled trial (RCT) across all EDs in a metropolitan area; 165 patients with the most ED visits for complaints of pain were randomized. For the treatment arm, drivers of ED use were identified by medical record review. Patients and their primary care providers were contacted by phone. Each patient was discussed at a community multidisciplinary meeting where recommendations for ED care were formed. The ED care recommendations were stored in an ED information exchange system that faxed them to the treating ED provider when the patient presented to the ED. The control arm was subjected to treatment as usual. Results: The intervention arm experienced a 34% decrease (incident rate ratios=0.66, p < 0.001; 95% confidence interval 0.57-0.78) in ED visits and an 80% decreases (odds ratio = 0.21, p = 0.001) in the odds of receiving an opioid prescription from the ED relative to the control group. Declines of 43.7%, 53.1%, 52.9%, and 53.1% were observed in the treatment group for morphine milligram equivalents, controlled substance pills, prescriptions, and prescribers, respectively. Conclusion: This RCT showed the effectiveness of a citywide ED care coordination program in reducing ED visits and controlled substance prescribing.

Cost-Effective: Emergency Department Care Coordination With a Regional Hospital Information System

Murphy, S. M. & Neven, D. (2014). Journal of Emergency Medicine, 47(2), 223-231.

Abstract – Background: Frequent and unnecessary utilization of the emergency department (ED) is often a sign of serious latent patient issues, and the associated costs are shared by many. Helping these patients get the care they need in the appropriate setting is difficult given their complexity, and their tendency to visit multiple EDs. Study Objectives: We analyzed the cost-effectiveness of a multidisciplinary ED-care-coordination program with a regional hospital information system capable of sharing patients’ individualized care plans with cooperating EDs. Methods: ED visits, treatment costs, cost per visit, and net income were assessed pre- and postenrollment in the program using nonparametric bootstrapping techniques. Individuals were categorized as frequent (3-11 ED visits in the 365 days preceding enrollment) or extreme (? 12 ED visits) users. Regression to the mean was tested using an adjusted measure of change. Results: Both frequent and extreme users experienced significant decreases in ED visits (5 and 15, respectively; 95% confidence intervals [CI] 2-5 and 13-17, respectively) and direct-treatment costs ($1285; 95% CI $492-$2364 and $6091; 95% CI $4298-$8998, respectively), leading to significant hospital cost savings and increased net income ($431; 95% CI $112-$878 and $1925; 95% CI $1093-$3159, respectively). The results further indicate that fewer resources were utilized per visit. Regression to the mean did not seem to be an issue. Conclusions: When examined as a whole, research on the program suggests that expanding it would be an efficient allocation of hospital, and possibly societal, resources.

Effectiveness of Case Management Strategies in Reducing Emergency Department Visits in Frequent User Patient Populations: A Systematic Review

Kumar, G. S. & Klein, R. (2013). Journal of Emergency Medicine, 44(3), 717.729.

Abstract – Background: Case management (CM) is a commonly cited intervention aimed at reducing Emergency Department (ED) utilization by “frequent users,” a group of patients that utilize the ED at disproportionately high rates. Studies have investigated the impact of CM on a variety of outcomes in this patient population. Objectives: We sought to examine the evidence of the effectiveness of the CM model in the frequent ED user patient population. We reviewed the available literature focusing on the impact of CM interventions on ED utilization, cost, disposition, and psychosocial variables in frequent ED users. Discussion: Although there was heterogeneity across the 12 studies investigating the impact of CM interventions on frequent users of the ED, the majority of available evidence shows a benefit to CM interventions. Reductions in ED visitation and ED costs are supported with the strongest evidence. Conclusion: CM interventions can improve both clinical and social outcomes among frequent ED users.