Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial⋆

ObjectiveThe objective of the study was to test the hypothesis that clinical case management is more cost-effective than usual care for frequent users of the emergency department (ED).MethodsThe study is a 24-month randomized trial obtaining data on psychosocial problems through interviews and service usage and cost data from administrative records.ResultsTwo-hundred fifty-two frequent users were randomized (167 to case management, 85 to usual care). Case management was associated with statistically significant reductions in psychosocial problems common among ED frequent users, including homelessness, alcohol use, lack of health insurance and social security income, and financial need. Case management was associated with statistically significant reductions in ED use and cost. Case management and usual care patients did not differ in use or cost of other hospital services.ConclusionsCase management appears cost-effective for ED frequent users because it yields statistically and clinically significant reductions in psychosocial problems at a cost similar to that of usual care.