The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64766

Robert L. Okin, MD, Alicia Boccellari, PhD, Martha Shumway, PhD, and Kathy O'Brien, LCSW. Department of Psychiatry, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Rm 7M, San Francisco, CA 94110

Excess use of medical emergency services negatively impacts the healthcare system and the individuals who rely on the ER for their care. This study evaluated the effectiveness of a comprehensive clinical case management program, designed to reduce ER utilization and improve functioning and quality of life by providing supportive therapy, crisis intervention, and linkage to health, social and substance abuse services. 252 individuals with psychosocial problems who had used the ER 5 or more times in the preceding year were randomized to case management or usual care and followed for 24 months. Case management appears successful in reducing ER utilization and homelessness. In the year prior to study entry, participants visited the ER an average of 12 times. During the study period, the case management group averaged 4.3 visits in the first year and 1.9 visits in the second, significantly fewer than the usual care group, who averaged 6.4 visits the first year and 3.2 the second (p<.01). At study entry, 70% of participants were homeless. Homelessness in the case management group decreased to 33% by the end of the first year and 21% by the end of the second. Homelessness rates were significantly higher in the usual care group (51% and 39%) (p<.01). These initial results indicate that clinical case management was successful in achieving two of its primary goals for high users of the medical ER. Future analyses of costs and outcomes will provide additional information about the impact of case management in this population.

Learning Objectives:

• Recognize that clinical case management can reduce ER utilization and homelessness among high users of the medical emergency room.

Keywords: Case Management, Emergency Department/Room

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.