Effects on healthcare utilization of case management for frail older people: A randomized controlled trial (RCT)

• Case management had effect on some emergency department (ED) visits.
• Case management had effect on visits to physicians in outpatient care.
• Case management had no effect on hospital admissions.
• Case management had no effect on length of stay (LOS).

ObjectivesVarious healthcare interventions have been launched targeting the growing population of older people. The objective of this study was to investigate the of a case management intervention for frail old people (aged 65+ years) effects on healthcare utilization.Materials and methodsThe study was conducted in a municipality in southern Sweden and included people aged 65+ years who lived in their ordinary homes, were dependent in two or more activities of daily living (ADL), and had at least two hospital admissions, or four physician visits, in the previous year. One-hundred-fifty-three participants were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The one-year intervention comprised home visits, at least once a month, by case managers. Group differences were investigated 6–12 and 0–6 months before, and 0–6 and 6–12 months after, baseline.ResultsThe intervention group had, compared to the control group, significant lower mean number (0.08 vs. 0.37, p = 0.041) and proportion (17.4 vs. 46.9%, p = 0.016) of ED visits not leading to hospitalization 6–12 months after baseline. The intervention group also had a significantly lower mean number of visits to physicians in outpatient care 6–12 months after baseline (4.09 vs. 5.29, p = 0.047).ConclusionThe effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization, suggesting that they may have been less monitored than the intervention group. The intervention has the potential to reduce the burden on outpatient care and ED.