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

Watkins, Alan, Aslam, Rabeea’h Waseem ORCID: https://orcid.org/0000-0002-0916-9641, Driscoll, Timothy, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, Edwards, Bethan, Evans, Bridie Angela, Foster, Theresa, Fothergill, Rachael, Gripper, Penny, Gunson, Imogen M., John, Ann, Khanom, Ashra, Petterson, Robin, Porter, Alison, Rees, Nigel, Rosser, Andy, Scott, Jason, Sewell, Bernadette, Tee, Anna and Snooks, Helen 2026. 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 7 (5) , 100459. 10.1016/j.acepjo.2026.100459

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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.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Social Sciences (Includes Criminology and Education) Schools > Medicine Research Institutes & Centres > Centre For Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Publisher:	Wiley Open Access
ISSN:	2688-1152
Date of First Compliant Deposit:	20 July 2026
Date of Acceptance:	2 June 2026
Last Modified:	20 Jul 2026 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/188303

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