Effectiveness of Multidisciplinary "Case Management" Approaches to the Management of Patients Who Make High Use of the Emergency Ambulance Service: A Quasi-experimental Evaluation Using Linked Routine Records.
Journal of the American College of Emergency Physicians open · 2026-07-13 · Quasi-experimental
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.