Emergency department (ED) High users (HU), defined as having more than ten visits to the ED per year, are a small group of patients that use a significant proportion of ED resources. The High Users Resolution Group (GRHU) identifies and provides care to HU to improve their health conditions and reduce the frequency of ED visits by delivering patient-centered case management integrated care. The main objective of this study was to measure the impact of the GRHU intervention in reducing ED visits, outpatient appointments, and hospitalizations. As secondary objectives, we aimed to compare the GRHU intervention costs against its potential savings or additional costs. Finally, we intend to study the impact of this intervention across different groups of patients. We studied the changes triggered by the GRHU program in a retrospective, non-controlled before-after analysis of patients’ hospital utilization data on 6 and 12-month windows from the first appointment. A total of 238 ED HU were intervened. A sample of 152 and 88 patients was analyzed during the 6 and 12-month window, respectively. On the 12-month window, GRHU intervention was associated with a statistically significant reduction of 51% in ED visits and hospitalizations and a non-statistically significant increase in the total number of outpatient appointments. Overall costs were reduced by 43.56%. We estimated the intervention costs to be €79,935.34. The net cost saving was €104,305.25. The program’s Return on Investment (ROI) was estimated to be €2.3. Patient-centered case management for ED HU seems to effectively reduce ED visits and hospitalizations, leading to better use of resources.

中文翻译：

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葡萄牙医院急诊科高用户的病例管理干预：前后设计分析

急诊科 (ED) 高用户 (HU)，定义为每年到 ED 就诊次数超过 10 次，是使用大部分 ED 资源的一小部分患者。高用户解决小组 (GRHU) 通过提供以患者为中心的病例管理综合护理，确定并为 HU 提供护理，以改善他们的健康状况并减少就诊频率。本研究的主要目的是衡量 GRHU 干预在减少 ED 就诊、门诊预约和住院治疗方面的影响。作为次要目标，我们旨在将 GRHU 干预成本与其潜在节省或额外成本进行比较。最后，我们打算研究这种干预对不同患者群体的影响。我们回顾性研究了 GRHU 计划引发的变化，从第一次预约开始，对患者在 6 个月和 12 个月窗口内的医院利用率数据进行非对照前后分析。总共干预了 238 名 ED HU。分别在 6 个月和 12 个月的窗口期间分析了 152 名和 88 名患者的样本。在 12 个月的窗口中，GRHU 干预与 51% 的 ED 就诊和住院有统计学意义的减少以及门诊预约总数的非统计学显着增加有关。总成本降低了 43.56%。我们估计干预成本为 79,935.34 欧元。净成本节省为 104,305.25 欧元。该计划的投资回报 (ROI) 估计为 2.3 欧元。以患者为中心的 ED HU 病例管理似乎可以有效减少 ED 就诊次数和住院次数，从而更好地利用资源。