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Risk Stratification: A Cost-effective Approach to the Treatment of Patients With Chest Pain

Risk Stratification: A Cost-effective Approach to the Treatment of Patients With Chest Pain Abstract Necessity demands that clinical decisions be more heavily influenced by cost considerations. The medical profession has only recently recognized that our society cannot support the uncontrolled and perhaps limitless growth in health care expenditures. Thus, we are just beginning to evaluate potentially more efficient methods that could help minimize costs without sacrificing quality. Logic dictates that medical problems that are both common and relatively expensive be analyzed first. Less than one half of the patients admitted to coronary care units (CCUs) are ultimately shown to have acute myocardial infarctions, and a relatively large group of the patients who are observed in these very costly facilities are ultimately shown to have no evidence of myocardial ischemia.1 Therefore, a low-risk group may be identifiable and could include as many as 20% to 30% of the patients currently being considered for admission to CCUs. In this context, the report of Lee et References 1. Bloom BS, Peterson OL: End results, cost and productivity of coronary-care units. N Engl J Med 1973;288:72-78.Crossref 2. Lee TH, Cook EF, Weisberg M, et al: Acute chest pain in the emergency room: Identification and examination of low-risk patients. Arch Intern Med 1985;145:65-69.Crossref 3. Goldman L, Weinberg M, Weisberg M, et al: A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. N Engl J Med 1983;307:588-596.Crossref 4. Behar S, Schor S, Kariv I, et al: Evaluation of electrocardiogram in emergency room as a decision-making tool. Chest 1977;71:486-491.Crossref 5. Pozen MW, D'Agostino RB, Selker HP, et al: A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: A prospective multicenter clinical trial. N Engl J Med 1984;310:1273-1278.Crossref 6. Fuchs R, Scheidt S: Improved criteria for admission to cardiac care units. JAMA 1981;246:2037-2041.Crossref 7. Wackers FJT, Lie KI, Liem KL, et al: Potential value of thallium-201 scintigraphy as a means of selecting patients for the coronary care unit. Br Heart J 1979;41:111-117.Crossref 8. Nattel S, Warnica JW, Ogilvie RI: Indications for admission to a coronary care unit in patients with unstable angina. Can Med Assoc J 1980;122:180-184. 9. Lau YK, Smith J, Morrison SL, et al: Policy for early discharge after acute myocardial infarction. Br Med J 1980;280: 1489-1492.Crossref 10. Mulley AG, Thibault GE, Hughes RA, et al: The course of patients with suspected myocardial infarction: The identification of low-risk patients for early transfer from intensive care. N Engl J Med 1980;302:943-948.Crossref 11. Severance HW, Morris KG, Wagner GS: Criteria for early discharge after acute myocardial infarction: Validation in a community hospital. Arch Intern Med 1982;142:39-41.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Risk Stratification: A Cost-effective Approach to the Treatment of Patients With Chest Pain

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References (11)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1985.00360010061004
Publisher site
See Article on Publisher Site

Abstract

Abstract Necessity demands that clinical decisions be more heavily influenced by cost considerations. The medical profession has only recently recognized that our society cannot support the uncontrolled and perhaps limitless growth in health care expenditures. Thus, we are just beginning to evaluate potentially more efficient methods that could help minimize costs without sacrificing quality. Logic dictates that medical problems that are both common and relatively expensive be analyzed first. Less than one half of the patients admitted to coronary care units (CCUs) are ultimately shown to have acute myocardial infarctions, and a relatively large group of the patients who are observed in these very costly facilities are ultimately shown to have no evidence of myocardial ischemia.1 Therefore, a low-risk group may be identifiable and could include as many as 20% to 30% of the patients currently being considered for admission to CCUs. In this context, the report of Lee et References 1. Bloom BS, Peterson OL: End results, cost and productivity of coronary-care units. N Engl J Med 1973;288:72-78.Crossref 2. Lee TH, Cook EF, Weisberg M, et al: Acute chest pain in the emergency room: Identification and examination of low-risk patients. Arch Intern Med 1985;145:65-69.Crossref 3. Goldman L, Weinberg M, Weisberg M, et al: A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. N Engl J Med 1983;307:588-596.Crossref 4. Behar S, Schor S, Kariv I, et al: Evaluation of electrocardiogram in emergency room as a decision-making tool. Chest 1977;71:486-491.Crossref 5. Pozen MW, D'Agostino RB, Selker HP, et al: A predictive instrument to improve coronary-care-unit admission practices in acute ischemic heart disease: A prospective multicenter clinical trial. N Engl J Med 1984;310:1273-1278.Crossref 6. Fuchs R, Scheidt S: Improved criteria for admission to cardiac care units. JAMA 1981;246:2037-2041.Crossref 7. Wackers FJT, Lie KI, Liem KL, et al: Potential value of thallium-201 scintigraphy as a means of selecting patients for the coronary care unit. Br Heart J 1979;41:111-117.Crossref 8. Nattel S, Warnica JW, Ogilvie RI: Indications for admission to a coronary care unit in patients with unstable angina. Can Med Assoc J 1980;122:180-184. 9. Lau YK, Smith J, Morrison SL, et al: Policy for early discharge after acute myocardial infarction. Br Med J 1980;280: 1489-1492.Crossref 10. Mulley AG, Thibault GE, Hughes RA, et al: The course of patients with suspected myocardial infarction: The identification of low-risk patients for early transfer from intensive care. N Engl J Med 1980;302:943-948.Crossref 11. Severance HW, Morris KG, Wagner GS: Criteria for early discharge after acute myocardial infarction: Validation in a community hospital. Arch Intern Med 1982;142:39-41.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Jan 1, 1985

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