胸痛患者の緊急診療所ベースの加速診断プロトコルと入院の費用:ランダム化制御試験
R R Roberts1, R J Zalenski, E K Mensah
1Department of Emergency Medicine, Cook County Hospital/Rush University, Chicago, IL 60612, USA. rroberts@rush.edu
JAMA
|December 5, 1997
まとめ
加速診断プロトコル (ADP) は,低リスクの胸痛患者の入院,入院期間,および費用を大幅に削減します. このEDベースのアプローチは,潜在的急性心筋梗塞 (AMI) のより効率的で費用対効果の高い評価を提供します.
科学分野:
- 緊急医療 緊急医療
- 心臓病学 心臓病学
- 健康経済学 医療経済学
背景:
- 胸の痛みのために毎年入院する300万人以上の米国患者は,特に急性疾患のない患者は,かなりの費用を負います.
- 急速診断検査は,加速診断プロトコル (ADP) と胸痛観察ユニットの開発につながりました.
- 既存のプロトコルは,急性心筋梗塞 (AMI) の評価を必要とする患者のために,しばしば長期の入院と高額な支出をもたらします.
研究 の 目的:
- 胸痛患者の入院率,総費用,入院期間 (LOS) を減らすための緊急治療室 (ED) ベースの加速診断プロトコル (ADP) の有効性を評価する.
- 伝統的な入院患者評価と比較して,EDベースのADPの経済的影響と資源利用を評価する.
- ADPが低リスクの胸痛患者を安全に管理できるかどうかを判断し,それによって医療リソースの割り当てを最適化します.
主な方法:
- 胸痛患者に対する標準的な入院ケアに対してADPの利用を比較した予備的なランダム化対照試験が行われました.
- 患者は,主にアフリカ系アメリカ人およびヒスパニック系住民に焦点を当てて,大規模な都市公共の教科病院から選択されました.
- 検証されたアルゴリズムを使用して,AMI/ACIのリスクが低いと特定された合計165人の患者が,より大きなコホートである429人の患者からランダムに割り当てられました.
主要な成果:
- ADPで管理された患者の入院率は,対照群の100%と比較して45.2%で著しく低下しました (P<.001).
- 患者"人当たりの平均総費用は,ADPグループで567ドル (対照グループで1528ドル) と対照グループで2095ドル (P<.001) で減少した.
- 平均滞在期間 (LOS) も,対照群 (44.8時間) (P<.01) と比較して,ADP群 (33.1時間) で減少しました.
結論:
- EDベースのADPは,低リスクの胸痛患者の入院率を下げるのに効果的です.
- ADPの実施は,大幅なコスト削減と滞在期間短縮につながります.
- ADPは,緊急治療室での胸痛の効率的かつ費用対効果の高い評価,特に潜在的急性心筋梗塞または急性心不全症の有効な戦略です.
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