Because the natural history of acute myocardial infarction (AMI) is often characterized life-threatening complications or death, about 2 million patients with definite or suspected AMI are admitted to the hospital each year in the United States. The expenses related to interventions and evaluation protocols in the coronary care unit and at other levels of care make management of these patients among the most costly common problems countered by the health care system. To help develop optimal management strategies at would increase the efficiency of care with minimal adverse clinical consequences, propose an investigation of the non- clinical determinants of resource utilization that would focus on the inter-relationships of (1) initial level of care; (2) test utilization; (3) length of stay; & (4) long term survival. This analysis would be performed by merging information from two databases: the multicenter Chest Pain Study, which has collected extensive clinical data from the emergency department presentations and subsequent hospital courses of 1222 consecutive patients admitted with acute chest pain at Brigham and Women's Hospital; and the Hospital's fiscal database, which has detailed resource utilization information on all admitted patients. This merger will create a databank with tailed clinical and resource utilization data, thus allowing analyses of the nonclinical determinants of resource utilization to adjust for clinical differences between patient subsets. To these data, we will add newly-collected data on 1-3 year survival. In addition to describing resource utilization parameters (e.g. charges, length of stay, and estimated costs) for patient subsets, we plan to test four specific hypotheses: (1) Triage to higher levels of care leads to an increase in the length of hospitalization; (2) Certain test- ordering patterns lead to increases in length of stay; (3) Initial triage to a coronary care unit leads to increased test utilization; and (4) In low risk patients, clinical outcomes are not affected by test utilization or initial level of care. The calculation of charges and length of stay for patient subsets will prove useful in future cost-effectiveness analyses, and the testing of these hypotheses should have important implications for the development of optimal management strategies.
