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This systematic review evaluates effectiveness of interventions targeting adult frequent <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> users in reducing visit frequency and improving patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An a priori protocol was published in <jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content>. Two independent reviewers screened, selected, rated quality, and extracted data. Third\u2010party adjudication resolved disagreements. Rate ratios of post\u2010 versus pre\u2010intervention <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visits were calculated. Data sources were from a comprehensive search that included seven databases and the gray literature. Eligibility criteria for selecting studies included experimental studies assessing the effect of interventions on frequent users\u2019 <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visits and patient\u2010oriented outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 6,865 citations were identified and 31 studies included. Designs were noncontrolled (<jats:italic>n\u00a0=<\/jats:italic>\u00a021) and controlled (<jats:italic>n\u00a0=<\/jats:italic>\u00a04) before\u2013after studies and randomized controlled trials (<jats:italic>n\u00a0=<\/jats:italic>\u00a06). Frequent user definitions varied considerably and risk of bias was moderate to high. Studies examined general frequent users or those with psychiatric comorbidities, chronic disease, or low socioeconomic status or the elderly. Interventions included case management (<jats:italic>n\u00a0=<\/jats:italic>\u00a018), care plans (<jats:italic>n\u00a0=<\/jats:italic>\u00a08), diversion strategies (<jats:italic>n\u00a0=<\/jats:italic>\u00a03), printout case notes (<jats:italic>n\u00a0=<\/jats:italic>\u00a01), and social work visits (<jats:italic>n\u00a0=<\/jats:italic>\u00a01). Post\u2010 versus pre\u2010intervention rate ratios were calculated for 25 studies and indicated a significant visit decrease in 21 (84%) of these studies. The median rate ratio was 0.63 (interquartile range\u00a0= 0.41 to 0.71), indicating that the general effect of the interventions described was to decrease <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visits post\u2010intervention. Significant visit decreases were found for a majority of studies in subgroup analyses based on 6\u2010 or 12\u2010month follow\u2010up, definition thresholds, clinical frequent user subgroups, and intervention types. Studies reporting homelessness found consistent improvements in stable housing. Overall, interstudy heterogeneity was high.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Interventions targeting frequent <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> users appear to decrease <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visits and may improve stable housing. Future research should examine cost\u2010effectiveness and adopt standardized definitions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13060","type":"journal-article","created":{"date-parts":[[2017,1,13]],"date-time":"2017-01-13T11:45:20Z","timestamp":1484307920000},"page":"40-52","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":184,"title":["Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review"],"prefix":"10.1111","volume":"24","author":[{"given":"Jessica","family":"Moe","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott W.","family":"Kirkland","sequence":"additional","affiliation":[{"name":"Emergency Medicine Research Group University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Rawe","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria B.","family":"Ospina","sequence":"additional","affiliation":[{"name":"Respiratory Health Strategic Clinical Network Alberta Health Services Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Vandermeer","sequence":"additional","affiliation":[{"name":"Alberta Research Centre for Health Evidence Department of Pediatrics University of Alberta Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandy","family":"Campbell","sequence":"additional","affiliation":[{"name":"J. 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