Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial⋆

Shumway, Martha; Boccellari, Alicia; O'Brien, Kathy; Okin, Robert L.

doi:10.1016/j.ajem.2007.04.021

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 2 , Pages 155-164, February 2008

Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial^⋆☆

Oral presentations include the following: November 2003, APHA, San Francisco, Calif; June 2004, Complexities of Co-Occurring Conditions, Washington, DC; May 2005, CREDO Symposium, Detroit, Mich.

Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, CA

Received 14 January 2007; received in revised form 7 April 2007; accepted 11 April 2007.

Abstract

Objective

The objective of the study was to test the hypothesis that clinical case management is more cost-effective than usual care for frequent users of the emergency department (ED).

Methods

The study is a 24-month randomized trial obtaining data on psychosocial problems through interviews and service usage and cost data from administrative records.

Results

Two-hundred fifty-two frequent users were randomized (167 to case management, 85 to usual care). Case management was associated with statistically significant reductions in psychosocial problems common among ED frequent users, including homelessness, alcohol use, lack of health insurance and social security income, and financial need. Case management was associated with statistically significant reductions in ED use and cost. Case management and usual care patients did not differ in use or cost of other hospital services.

Conclusions

Case management appears cost-effective for ED frequent users because it yields statistically and clinically significant reductions in psychosocial problems at a cost similar to that of usual care.