Evaluation of a Case-management Program for Frequent Emergency Department Users (DAUM)
3 juin 2026 mis à jour par: CHOUIHED Tahar, Central Hospital, Nancy, France
The DAUM Case-management Program for Frequent Users of the Nancy University Hospital Emergency Department: Evaluation Protocol
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.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Type d'étude
Interventionnel
Inscription (Réel)
153
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
-
-
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Nancy, France
- Nancy University Hospital
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-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Non
La description
Inclusion Criteria:
- adults
- who visited the ED of Nancy University Hospital between November 7th, 2022, and October 6th, 2023
- with at least four ED visits during the preceding year
- residing in Nancy or the surrounding urban areas
Exclusion Criteria:
- homeless patients
- patient refusal to participate
- patient's GP refusal to participate
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: N / A
- Modèle interventionnel: Affectation à un seul groupe
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Case-management program
Patients included in the case-management program
|
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. |
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Effectiveness
Délai: 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
|
Mean number of ED visits among included patients
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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
Délai: One year
|
Incremental cost-effectiveness ratio in cost per ED visit avoided
|
One year
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
Délai: One year
|
[number of patients who consented to participate in the DAUM program / number of eligible patients] x 100
|
One year
|
|
Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
Délai: One year
|
[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed] x 100
|
One year
|
|
Indicator Reach 3 - Percentage of patients who effectively participated in the program
Délai: One year
|
[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100
|
One year
|
|
Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians
Délai: One year
|
[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
|
One year
|
|
Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit
Délai: One year
|
[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
|
One year
|
|
Indicator Implementation 1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
Délai: One year
|
[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
|
One year
|
|
Indicator Implementation 2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician
Délai: One year
|
[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients] x 100
|
One year
|
|
Indicator Implementation 3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician
Délai: One year
|
[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
|
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
Délai: One year
|
[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
|
One year
|
|
Indicator Implementation 5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation
Délai: One year
|
[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
|
One year
|
|
Indicator Implementation 6 - Percentage of patients with a 3- to 6-month assessment
Délai: 3 and 6 months
|
[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated] x 100
|
3 and 6 months
|
|
Indicator Implementation 7 - Percentage of patients with a 1-year assessment
Délai: One year
|
[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year] x 100
|
One year
|
|
Indicator Implementation 8 - Percentage of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance R1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
Délai: One year
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[number of patients who consented to participate in the DAUM program / number of eligible patients] x 100, calculated each month
|
One year
|
|
Indicator Maintenance R2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance R3 - Percentage of patients who effectively participated in the program
Délai: One year
|
[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100, calculated each month
|
One year
|
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Indicator Maintenance A1 - Percentage of patients notified to the TSP by ED physicians
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance A2 - Percentage of patients who had been informed about the program during their ED visit
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance I1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance I2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance I3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician
Délai: One year
|
[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
|
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
Délai: One year
|
[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
|
One year
|
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Indicator Maintenance I5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation
Délai: One year
|
[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
|
One year
|
|
Indicator Maintenance I6 - Percentage of patients with a 3- to 6-month assessment
Délai: One year
|
[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated] x 100, calculated each month
|
One year
|
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Indicator Maintenance I7 - Percentage of patients with a 1-year assessment
Délai: One year
|
[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
|
One year
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Darraj A, Hudays A, Hazazi A, Hobani A, Alghamdi A. The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review. Healthcare (Basel). 2023 Jan 29;11(3):385. doi: 10.3390/healthcare11030385.
- Gabet M, Armoon B, Meng X, Fleury MJ. Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review. Am J Emerg Med. 2023 Dec;74:1-8. doi: 10.1016/j.ajem.2023.09.008. Epub 2023 Sep 9.
- Reinhart L, Dechartres A, Beaune S, Bonnet-Zamponi D, Chauvin A, Yordanov Y. Clinical and sociodemographic factors associated with frequent use of emergency services by persons of advanced age in Paris: a nested case-control study. Emergencias. 2025 Feb;37(1):7-14. doi: 10.55633/s3me/114.2024. English, Spanish.
- Calastri C, Buckell J, Crastes Dit Sourd R. Avoidable visits to UK emergency departments from the patient perspective: A recursive bivariate probit approach. Health Policy. 2025 Apr;154:105265. doi: 10.1016/j.healthpol.2025.105265. Epub 2025 Feb 12.
- Sartini M, Carbone A, Demartini A, Giribone L, Oliva M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in Emergency Department: Causes, Consequences, and Solutions-A Narrative Review. Healthcare (Basel). 2022 Aug 25;10(9):1625. doi: 10.3390/healthcare10091625.
- Ohaiba MM, Anamazobi EG, Okobi OE, Aguda K, Chukwu VU. Trends and Patterns in Emergency Department Visits: A Comprehensive Analysis of Adult Data From the National Center for Health Statistics (NCHS) Database. Cureus. 2024 Aug 3;16(8):e66059. doi: 10.7759/cureus.66059. eCollection 2024 Aug.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude (Réel)
7 novembre 2022
Achèvement primaire (Réel)
31 octobre 2024
Achèvement de l'étude (Réel)
31 octobre 2024
Dates d'inscription aux études
Première soumission
19 mai 2026
Première soumission répondant aux critères de contrôle qualité
3 juin 2026
Première publication (Réel)
9 juin 2026
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
9 juin 2026
Dernière mise à jour soumise répondant aux critères de contrôle qualité
3 juin 2026
Dernière vérification
1 juin 2026
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 2022_PI_095
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
NON
Informations sur les médicaments et les dispositifs, documents d'étude
Étudie un produit pharmaceutique réglementé par la FDA américaine
Non
Étudie un produit d'appareil réglementé par la FDA américaine
Non
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