CONECT-6: a case-finding tool to identify patients with complex health needs

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Abstract

Background

Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population.

Methods

This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs.

Results

Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively.

Conclusions

The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06154-4.

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Most cited references 58

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Screening for Serious Mental Illness in the General Population

Ronald C Kessler, Peggy R. Barker, Lisa Colpe … (2003)

Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI.

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Characteristics of frequent users of emergency departments.

Jonathan A. Showstack, M Callaham, D Colby … (2006)

We identify frequent users of the emergency department (ED) and determine the characteristics of these patients. Using the 2000 to 2001 population-based, nationally representative Community Tracking Study Household Survey, we determined the number of adults (aged 18 and older) making 1 to 7 or more ED visits and the number of visits for which they accounted. Based on the distribution of visits, we established a definition for frequent user of 4 or more visits. Multivariate analysis assessed the likelihood that individuals with specific characteristics used the ED more frequently. An estimated 45.2 million adults had 1 or more ED visits. Overall, 92% of adult users made 3 or fewer visits, accounting for 72% of all adult ED visits; the 8% of users with 4 or more visits were responsible for 28% of adult ED visits. Most frequent users had health insurance (84%) and a usual source of care (81%). Characteristics independently associated with frequent use included poor physical health (odds ratio [OR] 2.54; 95% confidence interval [CI] 2.08 to 3.10), poor mental health (OR 1.70; 95% CI 1.42 to 2.02), greater than or equal to 5 outpatient visits annually (OR 3.02; 95% CI 1.94 to 4.71), and family income below the poverty threshold (OR 2.36; 95% CI 1.70 to 3.28). Uninsured individuals were more likely to report frequent use, but this result was only marginally significant (OR 2.38; 95% CI 0.99 to 5.74). Individuals who lacked a usual source of care were actually less likely to be frequent users. The majority of adults who use the ED frequently have insurance and a usual source of care but are more likely than less frequent users to be in poor health and require medical attention. Additional support systems and better access to alternative sites of care would have the benefit of improving the health of these individuals and may help to reduce ED use.

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Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.

Patrick Bodenmann, Olivier Hugli, Sophie Paroz … (2011)

Frequent users of emergency departments (EDs) are a relatively small group of vulnerable patients accounting for a disproportionally high number of ED visits. Our objective is to perform a systematic review of the type and effectiveness of interventions to reduce the number of ED visits by frequent users. We searched MEDLINE, EMBASE, CINAHL, PsychINFO, the Cochrane Library, and ISI Web of Science for randomized controlled trials, nonrandomized controlled trials, interrupted time series, and controlled and noncontrolled before-and-after studies describing interventions targeting adult frequent users of EDs. Primary outcome of interest was the reduction in ED use. We also explored costs analyses and various clinical (alcohol and drug use, psychiatric symptoms, mortality) and social (homelessness, insurance status, social security support) outcomes. We included 11 studies (3 randomized controlled trials, 2 controlled and 6 noncontrolled before-and-after studies). Heterogeneity in both study designs and definitions of frequent users precluded meta-analyses of the results. The most studied intervention was case management (n=7). Only 1 of 3 randomized controlled trials showed a significant reduction in ED use compared with usual care. Six of the 8 before-and-after studies reported a significant reduction in ED use, and 1 study showed a significant increase. ED cost reductions were demonstrated in 3 studies. Social outcomes such as reduction of homelessness were favorable in 3 of 3 studies, and clinical outcomes trended toward positive results in 2 of 3 studies. Interventions targeting frequent users may reduce ED use. Case management, the most frequently described intervention, reduced ED costs and seemed to improve social and clinical outcomes. It appears to be beneficial to patients and justifiable for hospitals to implement case management for frequent users in the framework of a clear and consensual definition of frequent users and standardized outcome measures. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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Author and article information

Contributors

Catherine Hudon:

ORCID: http://orcid.org/0000-0001-6140-9916

Catherine.Hudon@usherbrooke.ca

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 17 February 2021

Publication date PMC-release: 17 February 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 157

Affiliations

[1 ]GRID grid.86715.3d, ISNI 0000 0000 9064 6198, Department of Family Medicine and Emergency Medicine, , University of Sherbrooke, ; 3001 12e Avenue N, Sherbrooke, QC J1H 5H3 Canada

[2 ]GRID grid.86715.3d, ISNI 0000 0000 9064 6198, Department of Family Medicine and Emergency Medicine, , University of Sherbrooke, ; Pavillon Z7-Room 3007, 3001, 12e Avenue Nord, Sherbrooke, QC J1H 5N4 Canada

[3 ]GRID grid.14848.31, ISNI 0000 0001 2292 3357, Nursing Faculty, , University of Montreal, ; Pavillon Marguerite-d’Youville, C.P. 6128 succ. Centre-ville, Montréal, QC H3C 3J7 Canada

[4 ]Integrated University Health and Social Services Centre of Saguenay–Lac-Saint-Jean, 930 rue Jacques-Cartier E, Chicoutimi, QC G7H 7K9 Canada

Author information

Catherine Hudon http://orcid.org/0000-0001-6140-9916

Article

Publisher ID: 6154

DOI: 10.1186/s12913-021-06154-4

PMC ID: 7891167

PubMed ID: 33596929

SO-VID: 63240b49-d606-47cc-8df2-7d9a24d8a33f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 23 June 2020

Date accepted : 3 February 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;

Award ID: 318327

Award Recipient : Catherine Hudon

Funded by: Quebec SPOR Support Unit

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: case-finding tool,complexity,chronic diseases,ambulatory care sensitive condition,case management,frequent user

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: case-finding tool, complexity, chronic diseases, ambulatory care sensitive condition, case management, frequent user

CONECT-6: a case-finding tool to identify patients with complex health needs

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

Related collections

International Journal of Applied Technology in Medical Sciences

Most cited references 58

Screening for Serious Mental Illness in the General Population

Characteristics of frequent users of emergency departments.

Effectiveness of interventions targeting frequent users of emergency departments: a systematic review.

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