20 research outputs found
Health care costs of case management for frequent users of the emergency department: Hospital and insurance perspectives
In most emergency departments (EDs), few patients account for a relatively high number of ED visits. To improve the management of these patients, the university hospital of Lausanne, Switzerland, implemented an interdisciplinary case management (CM) intervention. This study examined whether the CM intervention-compared with standard care (SC) in the ED-reduced costs generated by frequent ED users, not only from the hospital perspective, but also from the third-party payer perspective, that is, from a broader perspective that takes into account the costs of health care services used outside the hospital offering the intervention.
In this randomized controlled trial, 250 frequent ED users (>5 visits during the previous 12 months) were allocated to either the CM or the SC group and followed up for 12 months. Cost data were obtained from the hospital's analytical accounting system for the entire sample and from health insurance companies for a subgroup (n = 140). Descriptive statistics and multivariate regressions were used to make comparisons between groups and assess the contribution of patient characteristics to the main cost components.
At the end of the 12-month follow-up, 115 patients were in the CM group and 115 in the SC group (20 had died). Despite differences in economic costs between patients in the CM intervention and the SC groups, our results do not show any statistically significant reduction in costs associated with the intervention, either for the hospital that housed the intervention or for the third-party payer. Frequent ED users were big users of health services provided by both the hospital and community-based services, with 40% of costs generated outside the hospital that housed the intervention. Higher age, Swiss citizenship, and having social difficulty increased costs significantly.
As the role of the CM team is to guide patients through the entire care process, the intervention location is not limited to the hospital but often extends into the community
Demographic characteristics of participating patients by study arm.
<p>Abbreviations: ED, Emergency department; SD, Standard deviation.</p
Questionnaire responses from participants declining HIV testing.
<p>Questionnaire responses from participants declining HIV testing.</p
Association between the number of Federal Office of Public Health (FOPH) HIV risk factors and HIV rapid test acceptance among patients assigned to the targeted arm.
<p>Association between the number of Federal Office of Public Health (FOPH) HIV risk factors and HIV rapid test acceptance among patients assigned to the targeted arm.</p
Flowchart diagram demonstrating primary and final HIV testing rates with targeted testing and non-targeted screening following randomisation of 160 patients presenting to the emergency department.
<p>Abbreviations: FOPH, Federal Office of Public Health; USI, unprotected sexual intercourse.</p
HIV risk factors among targeted-arm patients accepting or declining the offer of rapid HIV testing.
<p>HIV risk factors among targeted-arm patients accepting or declining the offer of rapid HIV testing.</p
Flow chart showing the sequence of patient inclusion, study patient participation (questionnaire and rapid HIV testing) and doctor participation (questionnaire).
<p>Boxes with rounded corners indicate numbers; those with squared corners indicate processes.</p
Patient characteristics, in total and by HIV risk group.
<p>Patient characteristics, in total and by HIV risk group.</p
Flow chart showing the identification of Federal Office of Public Health (FOPH) indications for HIV testing, mention of HIV and offer of HIV testing by emergency department (ED) doctors, presented according to patient HIV risk group.
<p><sup>1</sup>Group A: patients with a reason for presenting suggestive of primary HIV infection; Group B: patients presenting HIV risk factors and/or reporting condomless sex with sexual partner(s) with risk factors; Group C: patients reporting condomless sex but no other risk factors; Group D: patients reporting no risk factors.</p
Patient reasons for not mentioning HIV during the consultation with their emergency department doctor.
<p>Patient reasons for not mentioning HIV during the consultation with their emergency department doctor.</p