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Completed

NCT Number: NCT07635680

Evaluation of a Case-management Program for Frequent Emergency Department Users

The DAUM case-management program for frequent users (FUs) of emergency department was developed to improve FUs identification and management. FUs were eligible if they had four ED visits or more in the previous year, and attended the ED between November, 2022 and October, 2023. Patients were identified in the ED and addressed to the territorial support platform. A personalized health coordination plan which included a care plan (care objectives) and a support plan (social objectives) was co-constructed by the support platform, the patient, their caregiver(s), and their GP. Follow-up assessments at three to six months and at one year evaluated whether individual objectives were achieved. The primary outcomes were participants' mean number of ED visits during their year of participation in the program compared to the previous year, and the incremental cost-effectiveness ratio (ICER), expressed as the cost per ED visit avoided. Secondary outcomes included reach, adoption, implementation, and maintenance indicators.

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Key information

Conditions

Frequent Users of Emergency Department (FUEDs) Disease Attributes Emergencies Pathologic Processes Pathological Conditions, Signs and Symptoms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Nancy University Hospital

Nancy, France

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • adults
  • who visited the ED of Nancy University Hospital between November 7th, 2022, and October 6th, 2023
  • with at least four ED visits during the preceding year
  • residing in Nancy or the surrounding urban areas

Exclusion criteria

  • homeless patients
  • patient refusal to participate
  • patient's GP refusal to participate

Treatment and study plan

Case-management program

Behavioral

FUs patients were identified by the admission nurse through an alert generated by the ED information system. The ED physician explained the DAUM program to the patient and notified the Territorial Support Platform (TSP). The TSP team contacted the patient and his/her GP to present the DAUM program, obtain their agreement to participate and collect additional information.

Once the patient included in the DAUM program, a Personalized Health Coordination Plan (PHCP) was co-constructed by the TSP team, in collaboration with the patient, hi/her GP, and other caregiver(s). The PHCP is divided into a care plan (with care objectives) and a support plan (with social obectives). Once the objectives of the care and support plans were identified for a patient, specific actions and timeframes were established for each objective. Follow-up assessments were conducted at three to six months from the inclusion and at one year.

Primary outcomes

  1. Effectiveness

    Time frame: Before-after comparison between the mean number of ED visits during the year of program participation and the mean number of ED visits in the preceding year

    Mean number of ED visits among included patients

  2. Cost-effectiveness

    Time frame: One year

    Incremental cost-effectiveness ratio in cost per ED visit avoided

Secondary outcomes

  1. Indicator Reach 1 - Percentage of patients who consented to participate in the DAUM program among eligible patients

    Time frame: One year

    [number of patients who consented to participate in the DAUM program / number of eligible patients] x 100

  2. Indicator Reach 2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed

    Time frame: One year

    [number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed] x 100

  3. Indicator Reach 3 - Percentage of patients who effectively participated in the program

    Time frame: One year

    [number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100

  4. Indicator Adoption 1 - Percentage of patients notified to the TSP by ED physicians

    Time frame: One year

    [number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)] x 100

  5. Indicator Adoption 2 - Percentage of patients who had been informed about the program during their ED visit

    Time frame: One year

    [number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP] x 100

  6. Indicator Implementation 1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit

    Time frame: One year

    [number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians] x 100

  7. Indicator Implementation 2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician

    Time frame: One year

    [number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients] x 100

  8. Indicator Implementation 3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician

    Time frame: One year

    [number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed] x 100

  9. Indicator Implementation 4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient

    Time frame: One year

    [number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP] x 100

  10. Indicator Implementation 5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation

    Time frame: One year

    [number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated] x 100

  11. Indicator Implementation 6 - Percentage of patients with a 3- to 6-month assessment

    Time frame: 3 and 6 months

    [number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated] x 100

  12. Indicator Implementation 7 - Percentage of patients with a 1-year assessment

    Time frame: One year

    [number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year] x 100

  13. Indicator Implementation 8 - Percentage of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment

    Time frame: One year

    [number of patients for whom all the PHCP actions were implemented as planned at the 1-year assessment / number of patients followed-up at 1 year] x 100

  14. Indicator Maintenance R1 - Percentage of patients who consented to participate in the DAUM program among eligible patients

    Time frame: One year

    [number of patients who consented to participate in the DAUM program / number of eligible patients] x 100, calculated each month

  15. Indicator Maintenance R2 - Percentage of patients who consented to participate in the program among patients to whom the program was proposed

    Time frame: One year

    [number of patients who consented to participate in the DAUM program / number of patients to whom the DAUM program was proposed] x 100, calculated each month

  16. Indicator Maintenance R3 - Percentage of patients who effectively participated in the program

    Time frame: One year

    [number of patients who effectively participated in the DAUM program (PHCP validated) / number of included patients] x 100, calculated each month

  17. Indicator Maintenance A1 - Percentage of patients notified to the TSP by ED physicians

    Time frame: One year

    [number of patients notified to the TSP by ED physicians / number of potentially eligible patients (i.e., patients identified as FU who visited the ED during the study period)] x 100, calculated each month

  18. Indicator Maintenance A2 - Percentage of patients who had been informed about the program during their ED visit

    Time frame: One year

    [number of patients who had been informed about the DAUM program during their ED visit / number of patients to whom the DAUM program was proposed by the TSP] x 100, calculated each month

  19. Indicator Maintenance I1 - Percentage of patients notified to the TSP by ED physicians within three days of their ED visit

    Time frame: One year

    [number of patients notified to the TSP by ED physicians within three days of their ED visit / number of patients notified to the TSP by ED physicians] x 100, calculated each month

  20. Indicator Maintenance I2 - Percentage of patients whose GP was contacted within 48 hours of the notification by an ED physician

    Time frame: One year

    [number of patients whose GP was contacted within 48 hours of the notification by an ED physician / number of eligible patients] x 100, calculated each month

  21. Indicator Maintenance I3 - Percentage of patients contacted by the TSP team within seven days of the notification by an ED physician

    Time frame: One year

    [number of patients contacted by the TSP team within seven days of the notification by an ED physician / number of patients to whom the DAUM program was proposed] x 100, calculated each month

  22. Indicator Maintenance I4 - Percentage of patients for whom a PHCP was validated within a month of the first contact between the TSP team and the patient

    Time frame: One year

    [number of patients for whom a PHCP was validated within a month of the first contact (between the TSP team and the patient) / number of patients who had a PHCP] x 100, calculated each month

  23. Indicator Maintenance I5 - Percentage of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation

    Time frame: One year

    [number of patients who benefited from the first actions of the PHCP within two weeks of the PHCP validation / number of patients who had a PHCP validated] x 100, calculated each month

  24. Indicator Maintenance I6 - Percentage of patients with a 3- to 6-month assessment

    Time frame: One year

    [number of patients with a 3-to 6-month assessment / number of patients who had a PHCP validated] x 100, calculated each month

  25. Indicator Maintenance I7 - Percentage of patients with a 1-year assessment

    Time frame: One year

    [number of patients with a 1-year assessment / number of patients not dead or lost to follow-up during the year] x 100, calculated each month

Sponsors and collaborators

Lead sponsor

Central Hospital, Nancy, France

Other

Collaborators

  • Dispositif d'appui à la coordination de Meurthe-et-Moselle
  • agence régionale de santé Grand Est

Registry information

Official study title

The DAUM Case-management Program for Frequent Users of the Nancy University Hospital Emergency Department: Evaluation Protocol

Acronym: DAUM

Important dates

Study start
2022
Primary completion
2024
Study completion
2024
First posted
Jun 9, 2026
Registry last updated
Jun 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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