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
Shawn Mondoux - firstname.lastname@example.org
Planning/ Thinking stage