Implementing a case management intervention for frequent users of the emergency department (I-CaM): an effectiveness-implementation hybrid trial study protocol

Véronique S Grazioli, Joanna C Moullin, Miriam Kasztura, Marina Canepa-Allen, Olivier Hugli, Judy Griffin, Francis Vu, Catherine Hudon, Yves Jackson, Hans Wolff, Bernard Burnand, Jean-Bernard Daeppen, Patrick Bodenmann, Véronique S Grazioli, Joanna C Moullin, Miriam Kasztura, Marina Canepa-Allen, Olivier Hugli, Judy Griffin, Francis Vu, Catherine Hudon, Yves Jackson, Hans Wolff, Bernard Burnand, Jean-Bernard Daeppen, Patrick Bodenmann

Abstract

Background: ED overcrowding represents a significant public health problem in developed countries. Frequent users of the emergency departments (FUEDs; reporting 5 or more ED visits in the past year) are often affected by medical, psychological, social, and substance use problems and account for a disproportionately high number of ED visits. Past research indicates that case management (CM) interventions are a promising way to reduce ED overcrowding and improve FUEDs' quality of life. There is, however, very limited knowledge about how to disseminate and implement this intervention on a large scale to diverse clinical settings, including community hospitals and non-academic centers. This paper describes the protocol of a research project aiming to implement a CM intervention tailored to FUEDs in the public hospitals with ED in the French-speaking region of Switzerland and evaluate both the implementation process and effectiveness of the CM intervention.

Methods: This research project uses a hybrid study design assessing both implementation and clinical outcomes. The implementation part of the study uses mixed methods a) to describe quantitatively and qualitatively factors that influence the implementation process, and b) to examine implementation effectiveness. The clinical part of the study uses a within-subject design (pre-post intervention) to evaluate participants' trajectories on clinical variables (e.g., quality of life, ED use) after receiving the CM intervention. We designed the study based on two implementation science frameworks. The Generic Implementation Framework guided the overall research protocol design, whereas the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework guided the implementation and effectiveness evaluations.

Discussion: This research project will contribute to implementation science by providing key insights into the processes of implementing CM into broader practice. This research project is also likely to have both clinical and public health implications.

Trial registration: NCT03641274 , Registered 20 August 2018.

Keywords: Case management; Frequent users of the emergency department; Implementation science; Vulnerability.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Swiss Ethics Committee on research involving humans of the Canton de Vaud (project number: 2018–00442). Informed consent will be obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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