• Gustaf Edgren, Jacqueline Anderson, Anders Dolk, Jarl Torgerson, Svante Nyberg, Tommy Skau, Birger C Forsberg, Joachim Werr, and Gunnar Öhlen.
• Departments of aMedical Epidemiology and Biostatistics bPublic Health Sciences, Karolinska Institutet cHematology Centre dDepartment of Quality and Patient Safety, Karolinska University Hospital eHealth Navigator fPublic Healthcare Services Committee Administration, Stockholm County Council, Stockholm gHealthcare Administration, Uppsala County Council, Uppsala hHealthcare Administration, Västra Götaland Region, Göteborg iHealthcare Administration, Linköping County Council, Linköping jDepartment of Medicine, Sörmland County Council, Nyköping, Sweden.
• Eur J Emerg Med. 2016 Oct 1; 23 (5): 344-50.

BackgroundA small group of frequent visitors to Emergency Departments accounts for a disproportionally large fraction of healthcare consumption including unplanned hospitalizations and overall healthcare costs. In response, several case and disease management programs aimed at reducing healthcare consumption in this group have been tested; however, results vary widely.ObjectivesTo investigate whether a telephone-based, nurse-led case management intervention can reduce healthcare consumption for frequent Emergency Department visitors in a large-scale setup.MethodsA total of 12 181 frequent Emergency Department users in three counties in Sweden were randomized using Zelen's design or a traditional randomized design to receive either a nurse-led case management intervention or no intervention, and were followed for healthcare consumption for up to 2 years.ResultsThe traditional design showed an overall 12% (95% confidence interval 4-19%) decreased rate of hospitalization, which was mostly driven by effects in the last year. Similar results were achieved in the Zelen studies, with a significant reduction in hospitalization in the last year, but mixed results in the early development of the project.ConclusionOur study provides evidence that a carefully designed telephone-based intervention with accurate and systematic patient selection and appropriate staff training in a centralized setup can lead to significant decreases in healthcare consumption and costs. Further, our results also show that the effects are sensitive to the delivery model chosen.

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