OUTCOMES OF MANAGEMENT STRATEGIES FOR CHEST PAIN

胸痛治疗策略的结果

• 批准号: 3372085
• 负责人: THOMAS H LEE
• 金额: $ 40.61万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-07-01 至 1993-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3372085
• 关键词: acute disease /disorder; angina pectoris; coronary intensive care; data collection methodology /evaluation; diagnosis design /evaluation; disease /disorder prevention /control; disease /disorder proneness /risk; emergency health services; health care cost /financing; health care service availability; health care service evaluation; health care service utilization; heart disorder diagnosis; hospital analysis; hospital length of stay; human subject; myocardial infarction; patient care management

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 include: (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.

因为急性心肌梗塞（AMI）通常与 威胁生命的复杂性，临床医生倾向于接受低 这种诊断为冠状动脉单位（CCU）的风险，效率低下可能 CCU管理协议的常规应用程序产生。 到 降低低风险患者，多元算法的RRSource利用率 为了鉴定低风险患者，已经开发了 前瞻性验证，但 有效鼓励其应用的有效低成本手段 确定。 此外，这些“决策辅助工具”对健康的影响 结果和资源利用尚未研究，并且仍然存在 未知。 该申请提出了一项3。5年的研究，该研究将评估低成本 主动干预将提供风险分层数据和分类 在初步评估时和关键时向医生提出建议 随后住院期间的要点。使用时间序列设计 有六个14周的周期（5个干预周和5个对照周 分隔为2周的冲洗期），干预对 资源利用和 将评估估计有1680名患者的健康结果。资源 利用终点将包括估计的成本和住宿时间； 健康结果将包括临床事件和健康状况 由医学结果研究调查工具。具体目的包括： （1）确定是否提供风险估计的干预措施和 急诊科评估时的分类推荐 降低CCU入院患者的患者的率很低 并发症； （2）确定是否提供风险估计 入院后的分类建议降低了资源利用率 根据估计成本，CCU和住院时间的衡量。 （3） 评估干预对健康结果的影响 演示后1和12个月的资源利用。 （4）分析 观察数据以评估不同的关系 管理策略和健康成果。这些分析将提供 对不同操纵策略的影响的重要见解 患者的结果和资源利用。