The purpose of this project is to provide fundamental information about coronary care unit (CCU) admitting practices in teaching and non-teaching hospitals, and to analyze these findings with the aim of assisting cost-effective and appropriate CCU use in this country. This work will be based on the continued analysis of data from the Multicenter Acute Ischemic Heart Disease Predictive Instrument Trial (NCHSR grant #R01 HS02068), which presents a unique opportunity for this type of inquiry. The proposed project would constitute a major portion of the activities of the Multicenter Cardiology and Health Services Research Unit (MCHSRU) that ran the original study, in collaboration with the Division of Clinical Decision Making at New England Medical Center. The support request is for a three-year period beginning September 1985. There are to be a number of component analyses to this project. A primary one will provide basic descriptive information about which physicians actually admit to the CCU, and differences in CCU admitting patterns and outcomes at urban major teaching centers, at teaching affilitated hospitals in smaller cities, and non-teaching rural hospitals. We will also be investigating non- clinical factors, such as patient insurance status, that might affect CCU use, as well as some clinical factors may promote inordinate CCU use. Additionally, because of the importance of the question and a unique opportunity to address it, we will study the impact of the lack of hospitalization on patients with acute myocardial infarctions who are sent home from emergency rooms.
