Evaluation of a Case-management Program for Frequent Emergency Department Users

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.

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