Document Detail


Cost-effectiveness of a new short-stay unit to "rule out" acute myocardial infarction in low risk patients.
MedLine Citation:
PMID:  7930247     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study attempted to determine the safety and costs of a new short-stay unit for low risk patients who may be admitted to a hospital to rule out myocardial infarction or ischemia. BACKGROUND: One strategy to reduce the costs of ruling out acute myocardial infarction in low risk patients is to develop alternatives to coronary care units. METHODS: The short-term and 6-month clinical outcomes and costs for 592 patients admitted to a short-stay coronary observation unit at Brigham and Women's Hospital with a low (< or = 10%) probability of acute myocardial infarction were compared with those for 924 consecutive comparison patients who were eligible for the same unit but were admitted to other hospital settings or discharged home. Actual costs were calculated using detailed cost-accounting methods that incorporated nursing intensity weights. RESULTS: The rate of major complications, recurrent myocardial infarction or cardiac death during 6 months after the initial presentation of the 592 patients admitted to the coronary observation unit was similar to that of the 924 comparison patients before and after adjustment for clinical factors influencing triage and initial diagnoses (adjusted relative risk 0.86, 95% confidence interval 0.49 to 1.53). Their median total costs (25th, 75th percentile) at 6 months ($1,927; 1,455, 3,650) were significantly lower than for comparison patients admitted to the wards $4,712; 1,868, 11,187), to stepdown or intermediate care units ($4,031; 2,069, 9,169) or to the coronary care unit ($9,201; 3,171, 20,011) but were higher than for comparison patients discharged home from the emergency department ($403; 403,927) before and after the same adjustments (all adjusted p < 0.0001). CONCLUSIONS: These data suggest that the coronary observation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarction admitted from the emergency department. Its replication in other hospitals should be tested.
Authors:
J M Gaspoz; T H Lee; M C Weinstein; E F Cook; P Goldman; A L Komaroff; L Goldman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  24     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1994 Nov 
Date Detail:
Created Date:  1994-11-22     Completed Date:  1994-11-22     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1249-59     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
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MeSH Terms
Descriptor/Qualifier:
Algorithms
Chest Pain / diagnosis*,  economics,  epidemiology
Coronary Care Units / economics*,  utilization
Cost-Benefit Analysis
Female
Follow-Up Studies
Hospital Costs
Hospital Units / economics*,  utilization
Humans
Length of Stay / economics*
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction / diagnosis*,  economics,  epidemiology
Outcome and Process Assessment (Health Care)
Patient Admission / statistics & numerical data
Prospective Studies
Risk Factors
Grant Support
ID/Acronym/Agency:
1RO1 HS06452-01/HS/AHRQ HHS; 1RO1 HS06452-02/HS/AHRQ HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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