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Interventions to Decrease Use in Prehospital and Emergency Care Settings Among Super-Utilizers in the United States:

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Programs targeting "super-utilizers" of acute care aim to reduce healthcare costs. While some interventions show promise, methodological weaknesses question the reliability of reported reductions in emergency care use.

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Area of Science:

  • Health Services Research
  • Public Health
  • Healthcare Management

Background:

  • High users of acute care services (
  • super-utilizers
  • ) drive significant healthcare spending.
  • Healthcare organizations are increasingly focused on cost-effective strategies for this population.

Purpose of the Study:

  • To systematically review evaluations of interventions aimed at reducing prehospital and emergency care use among U.S. super-utilizers.
  • To assess the effectiveness and methodological quality of existing interventions.

Main Methods:

  • Systematic review of peer-reviewed and grey literature.
  • Inclusion of 46 distinct evaluations of interventions for super-utilizers.
  • Focus on interventions targeting prehospital and emergency care utilization.

Main Results:

  • Case management was the most frequently evaluated intervention.
  • Several interventions reported reductions in prehospital and emergency care use and associated costs.
  • Widespread methodological weaknesses, including regression to the mean, were identified in the evaluated studies.

Conclusions:

  • Reported positive findings regarding intervention effectiveness are questionable due to study design limitations.
  • High-quality research is essential to accurately determine the impact of interventions on super-utilizers' healthcare utilization.
  • Further investigation is needed to develop reliable strategies for reducing acute care use in this high-cost population.