The DAUM case-management program for frequent users (FUs) of emergency department was developed to improve FUs identification and management. FUs were eligible if they had four ED visits or more in the previous year, and attended the ED between November, 2022 and October, 2023. Patients were identified in the ED and addressed to the territorial support platform. A personalized health coordination plan which included a care plan (care objectives) and a support plan (social objectives) was co-constructed by the support platform, the patient, their caregiver(s), and their GP. Follow-up assessments at three to six months and at one year evaluated whether individual objectives were achieved. The primary outcomes were participants' mean number of ED visits during their year of participation in the program compared to the previous year, and the incremental cost-effectiveness ratio (ICER), expressed as the cost per ED visit avoided. Secondary outcomes included reach, adoption, implementation, and maintenance indicators.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
153
FUs patients were identified by the admission nurse through an alert generated by the ED information system. The ED physician explained the DAUM program to the patient and notified the Territorial Support Platform (TSP). The TSP team contacted the patient and his/her GP to present the DAUM program, obtain their agreement to participate and collect additional information. Once the patient included in the DAUM program, a Personalized Health Coordination Plan (PHCP) was co-constructed by the TSP team, in collaboration with the patient, hi/her GP, and other caregiver(s). The PHCP is divided into a care plan (with care objectives) and a support plan (with social obectives). Once the objectives of the care and support plans were identified for a patient, specific actions and timeframes were established for each objective. Follow-up assessments were conducted at three to six months from the inclusion and at one year.
Nancy University Hospital
Nancy, France
Effectiveness
Mean number of ED visits among included patients
Time frame: Before-after comparison between the mean number of ED visits during the year of program participation and the mean number of ED visits in the preceding year
Cost-effectiveness
Incremental cost-effectiveness ratio in cost per ED visit avoided
Time frame: One year
Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
\[number of patients who consented to participate in the DAUM program / number of eligible patients\] x 100
Time frame: One year
Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
\[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed\] x 100
Time frame: One year
Indicator Reach 3 - Percentage of patients who effectively participated in the program
\[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients\] x 100
Time frame: One year
Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians
\[number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)\] x 100
Time frame: One year
Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit
\[number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP\] x 100
Time frame: One year
Indicator Implementation 1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
\[number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians\] x 100
Time frame: One year
Indicator Implementation 2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician
\[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients\] x 100
Time frame: One year
Indicator Implementation 3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician
\[number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed\] x 100
Time frame: One year
Indicator Implementation 4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient
\[number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP\] x 100
Time frame: One year
Indicator Implementation 5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation
\[number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated\] x 100
Time frame: One year
Indicator Implementation 6 - Percentage of patients with a 3- to 6-month assessment
\[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated\] x 100
Time frame: 3 and 6 months
Indicator Implementation 7 - Percentage of patients with a 1-year assessment
\[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year\] x 100
Time frame: One year
Indicator Implementation 8 - Percentage of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment
\[number of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment / number of patients followed-up at 1 year\] x 100
Time frame: One year
Indicator Maintenance R1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
\[number of patients who consented to participate in the DAUM program / number of eligible patients\] x 100, calculated each month
Time frame: One year
Indicator Maintenance R2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
\[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed\] x 100, calculated each month
Time frame: One year
Indicator Maintenance R3 - Percentage of patients who effectively participated in the program
\[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients\] x 100, calculated each month
Time frame: One year
Indicator Maintenance A1 - Percentage of patients notified to the TSP by ED physicians
\[number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)\] x 100, calculated each month
Time frame: One year
Indicator Maintenance A2 - Percentage of patients who had been informed about the program during their ED visit
\[number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
\[number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician
\[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician
\[number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient
\[number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation
\[number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I6 - Percentage of patients with a 3- to 6-month assessment
\[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated\] x 100, calculated each month
Time frame: One year
Indicator Maintenance I7 - Percentage of patients with a 1-year assessment
\[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year\] x 100, calculated each month
Time frame: One year
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