CONECT-6: a case-finding tool to identify patients with complex health needs

Catherine Hudon,Yohann Chiu,Maud-Christine Chouinard,Nicole Dubuc,Véronique Sabourin,Marie-France Dubois,Alain Vanasse,Mathieu Bisson,Nicolas Elazhary

doi:10.1186/s12913-021-06154-4

Abstract

BackgroundEarly identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population.MethodsThis prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs.ResultsTwo hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 95% respectively.ConclusionsThe case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED.

Highlights

Identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management
The average score of the Disease Burden Morbidity Assessment (DBMA) was 11.8 (SD = 7.2), which corresponded to a high burden [62]
Case management effectiveness relies on the casefinding process, that is to say the ability of identifying the patients most in need of the intervention [63]

Summary

Introduction

Identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. Fragmented, episodic and poorly coordinated, the care that these patients receive through the ED is often suboptimal in relation to their needs [12,13,14]. In many cases, this significant use of ED could be avoided by providing adequate care upstream [4, 15]. Over 80% of frequent users of ED present chronic conditions for which adequate ambulatory care can prevent deterioration or complications requiring visits to the ED or hospitalizations [16], and a majority present several conditions simultaneously [17]. Even though adequate care can prevent complications, a large proportion of hospital activities are devoted to ED visits and hospitalizations linked to these conditions [19]

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