The economic impact of alternative cardiac care unit treatment practices

A case-mix strategy was used with hospital chart-abstract data from New Jersey to estimate the hypothetical savings in the cost of Cardiac Care Unit (CCU) care in the state that would result from the state-wide implementation of the following five policies: limiting uncomplicated Acute-Myocardial Infraction (AMI) patients to seven days of hospitalization; treating uncomplicated AMI patients at home; using the CCU only for diagnoses for which it is widely accepted as effective; tightening CCU admission criteria; and tightening CCU discharge criteria. The selection of these policies was based on a review of the CCU literature and on empirical data from the New Jersey CCU system. The case-mix strategy involved; the creation and categorization of a list of diagnoses which are eligible for CCU treatment; the selection of a sample of hospitals for study; and the estimation of the savings which would result from the implementation of the hypothetical CCU policies throughout the state. The estimated savings were substantial compared to the total cost of CCU care in New Jersey, stressing the need for further investigation of the cost-effectiveness of current CCU treatment practices. In addition, the case-mix method used in this study is recommended for bringing considerations of the cost-effectiveness of clinical practice into public policy debates on the regulation of medical services.