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Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan
Susan F Saleeb1, Sarah R McLaughlin2, Dionne A Graham2
1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric chest pain reduced costs by 22%. This chest pain SCAMP streamlined cardiac testing and resource utilization effectively.
Area of Science:
- Pediatric Cardiology
- Health Economics
- Clinical Pathway Development
Background:
- Chest pain is a common presenting complaint in pediatric clinics, necessitating efficient and cost-effective diagnostic strategies.
- Standardized Clinical Assessment and Management Plans (SCAMPs) offer a structured approach to patient care, potentially optimizing resource utilization.
- Previous cost analyses for pediatric chest pain management were limited, highlighting a need for evaluating novel care algorithms.
Purpose of the Study:
- To evaluate the cost impact of implementing a SCAMP for pediatric patients presenting with chest pain.
- To assess changes in resource utilization and diagnostic testing patterns following SCAMP implementation.
- To identify potential areas for further cost reduction within the established care algorithm.
Main Methods:
- A retrospective review of resource utilization was conducted for 1517 pediatric patients (7-21 years) enrolled in the Chest Pain SCAMP from July 2010 to April 2014.
- A historic cohort of 406 patients with chest pain from 2009 was used as a baseline for cost comparison.
- Data included patient demographics, clinical presentation, diagnostic test utilization, and total healthcare charges.
Main Results:
- The SCAMP cohort exhibited higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%) compared to the historic cohort.
- Fewer patients in the SCAMP cohort had abnormal physical examination findings (1% vs 6%) or electrocardiograms (3% vs 5%).
- Echocardiogram use increased slightly (45% vs 41%), while other ancillary testing, including exercise stress testing (4% vs 28%), Holter monitors, and MRIs, significantly decreased, resulting in a 22% reduction in total charges ($822,625).
Conclusions:
- The Chest Pain SCAMP effectively streamlines cardiac testing and reduces overall resource utilization and healthcare costs in pediatric patients.
- Algorithm refinement, particularly concerning echocardiogram recommendations for exertional symptoms, may lead to further cost reductions.
- The SCAMP demonstrates a successful model for evidence-based, cost-conscious management of pediatric chest pain.
Objective:
Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain.
Design:
Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014.
Results:
Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort.
Conclusions:
The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms.
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