The   question of ED recidivism becomes more complex when we begin to devise   interventions to reduce visit frequency by individuals who are High System   Users (HSUs). Previous high-quality studies have examined the effectiveness   of intensive case management interventions among this group and determined   that they were not statistically significant in reducing ED use when compared   to outcomes among matched controls. Moreover, systematic reviews assessing   interventions geared towards lowering ED use among individuals who are HSUs   have yielded mixed results. Although it was demonstrated that there was a   trend of reducing the frequency of ED visits by individuals who are HSUs   across all studies, there was considerable population heterogeneity within   the included samples and some included studies had a high risk of bias.   Moreover, the implemented interventions differed between studies. This   heterogeneity among populations and interventions is an important finding and   a recurrent theme in the literature, which further complicates the   determination of the best approach to providing patient-centered care to   individuals who are HSUs. Looking beyond ED attendance, health system   resource consumption has also been addressed with multimodal social   interventions and demonstrated, in one large trial, to have no effect.

Authors: Shawn Mondoux, Iwona Bielska, Ivy Cheng