Effectiveness of Multidisciplinary "Case Management" Approaches to the Management of Patients Who Make High Use of...

A minority of people make high use of emergency ambulance services. Some UK ambulance services have deployed multidisciplinary case management for these patients. This approach extends usual (within-service) care provision to include input from other agencies such as social care. We aimed to evaluate the effectiveness of case management compared with usual care.

Natural experiment retrospective cohort study with patients from 4 UK ambulance services. We accessed anonymized electronic health records for patient cohorts identified by ambulance services. We compared patient-level outcomes based on mortality and emergency health contacts within 6 months of patient eligibility for case management. Cohorts were compared using logistic regression models, adjusting for ambulance service, patient characteristics, and service use in the 6 months before patients became eligible.

We found no differences between case management (intervention; n = 550) and usual care (control; n = 633) cohorts for our primary outcome, defined as death or any emergency health contact within 6 months. Nearly all patients recorded at least 1 such contact: 526 of 550 (95.6%) in the intervention cohort, compared with 601 of 633 (94.9%) in the control (adjusted odds ratio 1.159; 95% CI, 0.595-2.255). Mortality at 6 months was high: 58 of 550 (10.5%) in the intervention cohort and 89 of 633 (14.1%) in the control cohort.

We found no evidence for the clinical effectiveness of multidisciplinary case management over within-service usual care. Study patients had a high risk of death within 6 months of eligibility for case management, and almost all made at least 1 recorded emergency health contact in that period.