Because acute myocardial infarction (AMI) is often associated with life-threatening complicaticns, clinicians tend to admit patients with low risks of this diagnosis to the coronary unit (CCU), where inefficiency may result from the routine applicatiion of CCU Management protocols. To reduce rrsource utilization by low risk patients, multivariate algorithms for the identification of low risk patients have been developed and prospectively validated, but an effective low-cost means of encouraging their application has not been identified. Furthermore, the impact of these """"""""decision aids"""""""" upon health outcomes and resource utilization has not been studied and remains unknown. This application proposes a 3.5-year study that will evaluate a low-cost active intervention that will provide risk stratification data and triage recommendations to physicians at the time of initial evaluation and at key points during the subsequent hospitalization. Using a time-series design with six 14 week cycles (5 intervention weeks and 5 control weeks separated by 2 week washout periods), the effect of the intervention upon resource utilization and health outcomes of an estimated 1680 patients will be assessed. Resource utilization endpoints will include estimated cost and length of stay; health outcomes will include clinical events and health status as measured by the Medical Outcome Study survey instrument.
Specific aims i nclude: (1) To determine whether an intervention that provides risk estimates and triage recommendtions at the time of the emergency department evaluation decreases rates of CCU admission of patients who are at low risk of major complications; (2) To determine whether the provision of risk estimates and triage recommendations after admission decreases resource utilization as measured by estimated costs and CCU and hospital lengths of stay. (3) To evaluate the intervention's impact on health outcomes and total resource utilization at 1 and 12 months after presentation. (4) To analyze observational data to evaluate the relationships between different management strategies and health outcomes. These analyses will provide important insights into the impact of different mangement strategies on patient outcomes and resource utilization.
| Fleischmann, K E; Goldman, L; Robiolio, P A et al. (1994) Echocardiographic correlates of survival in patients with chest pain. J Am Coll Cardiol 23:1390-6 |
