Table 3.
Summary of Interventions and Outcomes
| Intervention | Crane (2012) | DeHaven (2012) | Edgren (2016) | Enard (2013) | Grimmer-Somers (2010) | Grover (2018) | Hardin (2017) | Lin (2017) | Murphy (2013) | Navratil-Strawn (2014) | Okin (2000) | Reinius (2012) | Seaberg (2017) | Shumway (2008) | Stokes-Buzzelli (2010) | Tadros (2012) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Case management/ care coordination/ acute care plans | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
| Financial assistance (social security) | X | |||||||||||||||
| Goal setting | X | |||||||||||||||
| Group therapy | X | X | X | |||||||||||||
| Harm reduction services | X | |||||||||||||||
| Housing | X | X | X | |||||||||||||
| Individual visits / CHW/ Nurse | X | X | X | X | X | X | X | X | ||||||||
| Mentoring | X | |||||||||||||||
| Monetary assistance with pharmacy, lab tests and other medical costs | X | |||||||||||||||
| Multidisciplinary | X | X | X | X | X | X | ||||||||||
| Problem solving | X | |||||||||||||||
| Referral to specialists and other services including social services | X | X | X | X | X | X | X | X | X | X | X | |||||
| Telephone | X | X | X | X | X | X | X | X | X | |||||||
| Transportation | X | X | ||||||||||||||
| Change in ED use | ↓ | ↓ | Mixed | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ ED use but not in inpatient | ↓ | ↓ |
| Magnitude of change | ED use dropped from a rate of 0.58 per patient per month to 0.23** | Fewer ED visits, 0.93 vs 1.44** | 12% decrease in hospitalisation (95%CI 4–19%) | V | 30 ED presentations by 11 users in 2006 dropped to 22 presentations by 9 users in 2009. | 830 fewer ED visits and a 49.26% change** | Mean difference of 5.5 and a 37.4% change** | 35% fewer ED visits | frequent users decreased by 5 visits (95% CI of 2–5); extreme users decreased by 15 visits (95% CI of 13–17)* | ED visits decreased by 178/1000 visits; hospital admission by 53/1000 visits* | Median number of visits decreased from 15 to 9 visits (95% CI of 3–7 visits)** | RR 0.77 (95% CI of 0.69–0.86) | 13.2% decrease in ED use from 1148 to 996 visits** | V | Visits decreased by 25% from 67.4 to 50.5 (95% CI 0.3 to 33)* | Visits decreased by 28.1% from 199 to 143** |
| Change in cost | ↓ | ↓ | Mixed | ↓ | ↑ outpatient clinic use. ↓ crisis ED use. | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | ↓ | Effective but not cost saving | ↓ | ↓ |
| Magnitude of change | Hospital charges dropped from $1167 per patient per month to $230** | $1188 vs $446** | V | V | NR | $2,785,690 absolute change and 47.81% change** | Mean difference of $6290 and 47.9%** | ED costs were 15% lower | Decrease in frequent ED use by $1285 (95% CI of $492–$2364); extreme ED use decreased by $6091 (95% CI of $4298–$8998)* | A saving of $21 per member per month for ED visits or $59 per member per month on admissions. | ED costs decreased from $4124 to $2192 (95% CI $1013 to $2459 to); and inpatient costs decreased from $8330 to $2786 (95% CI $0 to $8330).** | 45% decrease in total cost per patient** | 26.6% decrease (95% CI 26.1 to 27%)** | V | decreased by 24% from $64,721 to $49,208 (95% CI $83 to -$30,943)* | 12.7% decrease in costs from $413,410 to $360,779 |
V Variable rate
NR Not reported
*p < 0.05
**p < 0.01
Entries in boldface summarise the main outcomes