Agile Comprehensive Care: A Pragmatic Trial of a Systemic Intervention for High Utilizers of Emergency Departments

Background: The agile Comprehensive Care (aCC) is a service that was developed in response to a detailed analysis of the most frequent attendees to Monash Health's emergency departments (ED). Analyses revealed a group of clients with complex mental health issues who were receiving disintegrated care resulting in suboptimal clinical outcomes, high demand on resources and substantial costs. In a real-life setting, we sought to evaluate, through follow-up, the effectiveness of the aCC service, which aimed at stabilizing the system's response to high utilizers by developing comprehensive service plans, modelled on the General Psychiatric Management Framework, to be utilized by all clinicians no matter where the person presents within the system of care. Methods: A single group pre/post study was undertaken involving the follow-up analysis of 27 patients discharged from the aCC clinic after intervention. A comparison of 12-month median pre-aCC and median post-aCC service utilization and service costs was undertaken using Wilcoxon signed rank tests with effect sizes reported as r. In addition, we received feedback from staff within the health service who received support from aCC for their complex clients. Results: ED presentations decreased significantly from the pre-intervention period to the post-intervention by a median of 15 visits to a median of four visits. Mental health ED presentations decreased from a median of nine visits to one visit. Median service costs decreased from AUS 64,921 to AUS 19,329. aCC support gave staff greater confidence in working with this complex group. Conclusions: agile Comprehensive Care, involving the development of a systems-wide treatment plan coupled with patient and clinician support, improved outcomes and reduced service usage and costs for a complex group of high utilizer patients.