基于急诊室的加快诊断协议与胸痛患者住院的成本:随机对照试验
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
概括
加快诊断协议 (ADP) 显著降低了低风险胸痛患者的入院,住院时间和成本. 这种基于ED的方法为潜在的急性心肌梗塞 (AMI) 提供了更有效和更具成本效益的评估.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
背景情况:
- 美国每年因胸痛住院的300多万患者需要付出相当大的费用,特别是那些没有急性疾病的患者.
- 快速诊断测试导致了加速诊断协议 (ADP) 和胸痛观察单元的发展.
- 现有的方案往往导致长时间住院和高开支的病人需要评估急性心肌梗塞 (AMI).
研究的目的:
- 评估基于急诊室 (ED) 的加速诊断协议 (ADP) 在降低胸痛患者住院率,总成本和住院时间 (LOS) 的有效性.
- 与传统的住院患者评估相比,评估基于ED的ADP的经济影响和资源利用.
- 确定ADPs是否可以安全管理低风险的胸痛患者,从而优化医疗保健资源配置.
主要方法:
- 进行了一项前性随机对照试验,将ADP利用率与胸痛患者的标准住院护理进行比较.
- 患者从一个大型城市公立教学医院中被选中,重点关注主要是非洲裔美国人和西班牙裔人口.
- 总共有165名患者被确定为AMI/ACI风险低的患者,使用经过验证的算法,从429名患者的更大的队列中随机选择.
主要成果:
- 用ADP治疗的患者的住院率明显较低,为45.2%,而对照组的患者则为100% (P<.001).
- 每名患者的平均总成本在ADP组 (ADP组1528美元) 和对照组 (2095美元) (P<.001) 中减少了567美元.
- 与对照组 (44.8小时) 相比,ADP组的平均逗留时间 (LOS) 也减少了 (33.1小时) (P<.01).
结论:
- 基于ED的ADP在降低低风险胸痛患者住院率方面是有效的.
- 实施ADP带来了巨大的成本节约和停留时间缩短.
- 在急诊室,ADPs是有效和经济有效的评估胸痛的宝贵策略,特别是在潜在的急性心肌梗塞或急性心脏缺血的情况下.
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