Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review

Catherine Hudon, Maud-Christine Chouinard, Mireille Lambert, Fatoumata Diadiou, Danielle Bouliane, Jérémie Beaudin, Catherine Hudon, Maud-Christine Chouinard, Mireille Lambert, Fatoumata Diadiou, Danielle Bouliane, Jérémie Beaudin

Abstract

Objective: The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness.

Design: Thematic analysis review of CM studies.

Methods: We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level.

Results: Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration.

Conclusions: CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts.

Keywords: case management; frequent users; implementation; outcomes.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

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Figure 1
Scoping review flow chart of search results (2004–July 2017). CM, case management.

References

    1. Bodenheimer T, Berry-Millett R. Follow the money--controlling expenditures by improving care for patients needing costly services. N Engl J Med 2009;361:1521–3. 10.1056/NEJMp0907185
    1. Commission on the Reform of Ontario’s Public Services. Public services for Ontarians: a path to sustainability and excellence. Ottawa: Queen’s Printer for Ontario, 2012.
    1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010;56:42–8. 10.1016/j.annemergmed.2010.01.032
    1. Hansagi H, Olsson M, Sjöberg S, et al. . Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med 2001;37:561–7. 10.1067/mem.2001.111762
    1. Chan BT, Ovens HJ. Frequent users of emergency departments. Do they also use family physicians' services? Can. Fam. Physician 2002;48:1654–60.
    1. Byrne M, Murphy AW, Plunkett PK, et al. . Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med 2003;41:309–18. 10.1067/mem.2003.68
    1. Ruger JP, Richter CJ, Spitznagel EL, et al. . Analysis of costs, length of stay, and utilization of emergency department services by frequent users: implications for health policy. Acad Emerg Med 2004;11:1311–7. 10.1111/j.1553-2712.2004.tb01919.x
    1. Lee KH, Davenport L. Can case management interventions reduce the number of emergency department visits by frequent users? Health Care Manag 2006;25:155–9. 10.1097/00126450-200604000-00008
    1. Murphy AW, Leonard C, Plunkett PK, et al. . Characteristics of attenders and their attendances at an urban accident and emergency department over a one year period. J Accid Emerg Med 1999;16:425–7. 10.1136/emj.16.6.425
    1. Lowe RA, Localio AR, Schwarz DF, et al. . Association between primary care practice characteristics and emergency department use in a medicaid managed care organization. Med Care 2005;43:792–800. 10.1097/01.mlr.0000170413.60054.54
    1. Haggerty JL, Roberge D, Pineault R, et al. . Features of primary healthcare clinics associated with patients' utilization of emergency rooms: urban-rural differences. Healthc Policy 2007;3:72–85. 10.12927/hcpol.2007.19394
    1. Fuda KK, Immekus R. Frequent users of Massachusetts emergency departments: a statewide analysis. Ann Emerg Med 2006;48:16.e1–16.e8. 10.1016/j.annemergmed.2006.03.001
    1. Browne GB, Humphrey B, Pallister R, et al. . Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice. J Fam Pract 1982;14:63–71.
    1. Hansagi H, Allebeck P, Edhag O, et al. . Frequency of emergency department attendances as a predictor of mortality: nine-year follow-up of a population-based cohort. J Public Health Med 1990;12:39–44. 10.1093/oxfordjournals.pubmed.a042504
    1. Kersnik J, Svab I, Vegnuti M. Frequent attenders in general practice: quality of life, patient satisfaction, use of medical services and GP characteristics. Scand J Prim Health Care 2001;19:174–7.
    1. Althaus F, Paroz S, Hugli O, et al. . Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med 2011;58:41–52. 10.1016/j.annemergmed.2011.03.007
    1. Soril LJ, Leggett LE, Lorenzetti DL, et al. . Reducing frequent visits to the emergency department: a systematic review of interventions. PLoS One 2015;10:e0123660 10.1371/journal.pone.0123660
    1. Case Management Society of America. What is a case manager?
    1. Kumar GS, Klein R. Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review. J Emerg Med 2013;44:717–29. 10.1016/j.jemermed.2012.08.035
    1. Hudon C, Chouinard MC, Lambert M, et al. . Effectiveness of case management interventions for frequent users of healthcare services: a scoping review. BMJ Open 2016;6:e012353 10.1136/bmjopen-2016-012353
    1. Stokes J, Panagioti M, Alam R, et al. . Effectiveness of case management for ’At Risk' patients in primary care: a systematic review and meta-analysis. PLoS One 2015;10:e0132340 10.1371/journal.pone.0132340
    1. Phillips GA, Brophy DS, Weiland TJ, et al. . The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department. Med J Aust 2006;184:602–6.
    1. Okin RL, Boccellari A, Azocar F, et al. . The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med 2000;18:603–8. 10.1053/ajem.2000.9292
    1. Shumway M, Boccellari A, O’Brien K, et al. . Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. Am J Emerg Med 2008;26:155–64. 10.1016/j.ajem.2007.04.021
    1. Oeseburg B, Wynia K, Middel B, et al. . Effects of case management for frail older people or those with chronic illness: a systematic review. Nurs Res 2009;58:201–10. 10.1097/NNR.0b013e3181a30941
    1. Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005;10:6–20. 10.1258/1355819054308576
    1. Kastner M, Tricco AC, Soobiah C, et al. . What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol 2012;12:114 10.1186/1471-2288-12-114
    1. Miles MB, Huberman AM, Saldaña J. Qualitative Data Analysis: A methods sourcebook. 3rd ed London: Sage Publications Inc, 2014.
    1. Chaudoir SR, Dugan AG, Barr CH. Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures. Implement Sci 2013;8:22 10.1186/1748-5908-8-22
    1. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 2008;41:327–50. 10.1007/s10464-008-9165-0
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50 10.1186/1748-5908-4-50
    1. Crane S, Collins L, Hall J, et al. . Reducing utilization by uninsured frequent users of the emergency department: combining case management and drop-in group medical appointments. J Am Board Fam Med 2012;25:184–91. 10.3122/jabfm.2012.02.110156
    1. Shah R, Chen C, O’Rourke S, et al. . Evaluation of care management for the uninsured. Med Care 2011;49:166–71. 10.1097/MLR.0b013e3182028e81
    1. Pillow MT, Doctor S, Brown S, et al. . An Emergency Department-initiated, web-based, multidisciplinary approach to decreasing emergency department visits by the top frequent visitors using patient care plans. J Emerg Med 2013;44:853–60. 10.1016/j.jemermed.2012.08.020
    1. Rinke ML, Dietrich E, Kodeck T, et al. . Operation care: a pilot case management intervention for frequent emergency medical system users. Am J Emerg Med 2012;30:352–7. 10.1016/j.ajem.2010.12.012
    1. Tadros AS, Castillo EM, Chan TC, et al. . Effects of an emergency medical services-based resource access program on frequent users of health services. Prehosp Emerg Care 2012;16:541–7. 10.3109/10903127.2012.689927
    1. Wetta-Hall R. Impact of a collaborative community case management program on a low-income uninsured population in Sedgwick County, KS. Appl Nurs Res 2007;20:188–94. 10.1016/j.apnr.2006.08.009
    1. Grover CA, Crawford E, Close RJ. The efficacy of case management on emergency department frequent users: An Eight-Year Observational Study. J Emerg Med 2016;51:595–604. 10.1016/j.jemermed.2016.06.002
    1. Bodenmann P, Velonaki VS, Griffin JL, et al. . Case management may reduce emergency department frequent use in a universal health coverage system: a randomized controlled trial. J Gen Intern Med 2017;32:508–15. 10.1007/s11606-016-3789-9
    1. Segal L, Dunt D, Day SE, et al. . Introducing co-ordinated care (1): a randomised trial assessing client and cost outcomes. Health Policy 2004;69:201–13. 10.1016/j.healthpol.2003.12.016
    1. Sledge WH, Brown KE, Levine JM, et al. . A randomized trial of primary intensive care to reduce hospital admissions in patients with high utilization of inpatient services. Dis Manag 2006;9:328–38. 10.1089/dis.2006.9.328
    1. Peddie S, Richardson S, Salt L, et al. . Frequent attenders at emergency departments: research regarding the utility of management plans fails to take into account the natural attrition of attendance. N Z Med J 2011;124:61–6.
    1. Ross S, Curry N, Goodwin N. Case Management: What it is and how it can best be implemented. London, UK: The King’s Funds, 2011.
    1. Berry-Millett R, Bodenheimer TS. Care management of patients with complex health care needs. Synth Proj Res Synth Rep 2009.
    1. Petticrew M, Rehfuess E, Noyes J, et al. . Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute. J Clin Epidemiol 2013;66:1230–43. 10.1016/j.jclinepi.2013.06.005
    1. Shepperd S, Lewin S, Straus S, et al. . Can we systematically review studies that evaluate complex interventions? PLoS Med 2009;6:e1000086 10.1371/journal.pmed.1000086
    1. Pawson R. Nothing as Practical as a Good Theory. Evaluation 2003;9:471–90. 10.1177/1356389003094007
    1. ICHI. ICHI Alpha 2016.

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