Evaluation of a Case-management Program for Frequent Emergency Department Users (DAUM)
3 juni 2026 uppdaterad av: 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.
Studieöversikt
Status
Avslutad
Betingelser
Intervention / Behandling
Studietyp
Interventionell
Inskrivning (Faktisk)
153
Fas
- Inte tillämpbar
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studieorter
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-
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Nancy, Frankrike
- Nancy University Hospital
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Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
- Vuxen
- Äldre vuxen
Tar emot friska volontärer
Nej
Beskrivning
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
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Hälsovårdsforskning
- Tilldelning: N/A
- Interventionsmodell: Enskild gruppuppgift
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
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Experimentell: Case-management program
Patients included in the case-management program
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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. |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Effectiveness
Tidsram: 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
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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
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Cost-effectiveness
Tidsram: One year
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Incremental cost-effectiveness ratio in cost per ED visit avoided
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One year
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
Tidsram: One year
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[number of patients who consented to participate in the DAUM program / number of eligible patients] x 100
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One year
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Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
Tidsram: One year
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[number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed] x 100
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One year
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Indicator Reach 3 - Percentage of patients who effectively participated in the program
Tidsram: One year
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[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100
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One year
|
|
Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians
Tidsram: 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
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|
Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit
Tidsram: One year
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[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
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One year
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Indicator Implementation 1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
Tidsram: 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
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One year
|
|
Indicator Implementation 2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician
Tidsram: One year
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[number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients] x 100
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One year
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Indicator Implementation 3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician
Tidsram: One year
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[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
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One year
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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
Tidsram: One year
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[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
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One year
|
|
Indicator Implementation 5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation
Tidsram: 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
Tidsram: 3 and 6 months
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[number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated] x 100
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3 and 6 months
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Indicator Implementation 7 - Percentage of patients with a 1-year assessment
Tidsram: One year
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[number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year] x 100
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One year
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Indicator Implementation 8 - Percentage of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment
Tidsram: One year
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[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
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One year
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Indicator Maintenance R1 - Percentage of patients who consented to participate in the DAUM program among eligible patients
Tidsram: 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
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One year
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Indicator Maintenance R2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed
Tidsram: 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
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One year
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Indicator Maintenance R3 - Percentage of patients who effectively participated in the program
Tidsram: One year
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[number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100, calculated each month
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One year
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Indicator Maintenance A1 - Percentage of patients notified to the TSP by ED physicians
Tidsram: One year
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[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
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Indicator Maintenance A2 - Percentage of patients who had been informed about the program during their ED visit
Tidsram: One year
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[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
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Indicator Maintenance I1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit
Tidsram: 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
Tidsram: 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
Tidsram: 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
|
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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
Tidsram: 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
Tidsram: 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
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Indicator Maintenance I6 - Percentage of patients with a 3- to 6-month assessment
Tidsram: 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
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One year
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Indicator Maintenance I7 - Percentage of patients with a 1-year assessment
Tidsram: 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
|
Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Publikationer och användbara länkar
Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.
Allmänna publikationer
- 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.
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart (Faktisk)
7 november 2022
Primärt slutförande (Faktisk)
31 oktober 2024
Avslutad studie (Faktisk)
31 oktober 2024
Studieregistreringsdatum
Först inskickad
19 maj 2026
Först inskickad som uppfyllde QC-kriterierna
3 juni 2026
Första postat (Faktisk)
9 juni 2026
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
9 juni 2026
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
3 juni 2026
Senast verifierad
1 juni 2026
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- 2022_PI_095
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