Table 1

Description of the studies evaluating CM interventions among frequent users of healthcare services

Source (location)DesignDefinition of frequent usersnInterventionOutcomes
Bodenmann et al 39 (Switzerland)Randomised controlled trial5 ED visits and more in a yearI=125
A care plan was developed by a multidisciplinary team and offered counselling on substance abuse, patient navigation, referral to social, mental and health services and assistance in resolving income, housing, health insurance, education and domestic violence issues.No change on ED use
Crane et al 32
Non-randomised controlled study6 ED visits and more in 1 yearI=36
A care plan was developed by a multidisciplinary team and offered individual and group medical meetings, counselling group sessions and telephone access to a case manager.Reduction in ED use and in total healthcare cost
Grover et al 38
Before–after study5 ED visits and more in 1 month.199A care plan was developed by a multidisciplinary team and was entered into the ED electronic system. They offered referrals to healthcare and social services and limitation of narcotic prescriptions (if needed). A review of the care plan was done if changes occurred in a patient’s condition or use of ED services.Reduction in ED use
Lee and Davenport 8
Before–after study3 ED visits and more in 1 month associated with symptoms of unresolved pain, drug seeking or lack of primary care physician50With the collaboration of primary care providers, a nurse case manager offered referrals to healthcare and social services, assistance with insurance issues and limited narcotic prescriptions.No change on ED use
Peddie et al 42
(New Zealand)
Non-randomised controlled trial10 ED visits and more in 1 yearI=87
A care plan was developed by a multidisciplinary team (including the patient) and was entered into the ED electronic system. The CM intervention also offered free visits with a general practitioner and CM meetings with a multidisciplinary team for the patients with the most complex needs.No change on ED use
Phillips et al 22
Before–after study6 ED visits and more in 1 year60A multidisciplinary team offered hospital-based care, community healthcare, primary healthcare and short-term and long-term CM.Increased ED use, improved primary and community care engagement, improved housing stability, no change on number of admissions, ED disposition, ED length of stay, ED triage category, drug and alcohol use and EMS use
Pillow et al 34
Before–after studyTop 50 chronic ED frequent users50A care plan was developed by a multidisciplinary team and offered psychosocial and psychiatric assessments, pain contract, radiology and urinary toxicology studies, outpatient and managed care referrals. An ED tracking system was implemented to identify frequent users while facilitating access to the care plan.Reduction in ED use, but no change in number of admissions.
Rinke et al 35
Before–after studyTop 25 frequent EMS users10A care plan was developed by a case manager and offered coordinated care referrals to psychosocial services, patient education and telephone access to healthcare support.Reduction in EMS use and cost*
Segal et al 40 (Australia)Randomised controlled trialMore than US$4000 of healthcare costs over a 2-year periodI=2074
A care plan was developed by the care coordinator and the patient. CM intensity was determined by patients’ likely future risk of hospital admission: Low risk: care plan reviewed every 12 months; Medium- risk: care plan reviewed every 6 months and telephone contact to monitor implementation of the care plan and address emergent problems; High risk: care plan reviewed every 3 months and traditional intensive CM services including an advocacy role.Increase in total healthcare costs and hospital-based outpatient costs.
No change on admission costs, medication costs, quality of life and mortality
Shah et al 33
Non-randomised controlled study4 ED visits or admissions and more, or three admissions and more, or two admissions and more as well as 1 ED visit and more in 1 yearI=98
A care manager helped patients access and coordinate services needed. He offered goal setting and assistance, health navigation; access to support services, care transitions and communication with providers.Reduction in ED use and cost as well as admission cost, but no change on no of admissions.
Sledge et al 41
Randomised controlled trial2 admissions and more in 1 yearI=47
A care plan was developed by a multidisciplinary team and offered follow-up to the patient in primary care by promoting coordination of care, self-care patterns, coping skills, and providing assistance with referrals and appointments.No change on no of admissions, ED use, total healthcare costs, quality of life and patient satisfaction
Tadros et al 36
Before–after study10 EMS transports and more in a 1 year, or referred by fire and EMS personnel51A coordinator helped patients with access and coordination of needs. He offered investigation for factors underlying the excessive use of healthcare services, coordination of care with other health and social services and patient education.Reduction in EMS use and cost* as well as total healthcare cost*, but no change in no of admissions and cost, ED use and cost.
Before–after study3 ED visits and more in 6 months492A multidisciplinary team helped patient’s access to community resources, navigate the healthcare system, and find primary care resources. They offered goal setting, coordination of care, referrals for healthcare needs, patient education and supporting patient connections with informal support networks.Reduction in ED use and improved quality of life, but no change in health locus of control.
  • C, Control group; CM, case management; ED, emergency department; EMS, emergency medical services; I, Intervention group.

  • * Not stated if the outcome was significant or not.