低危胸痛患者院前评估后的住院医疗利用、结局和费用。

In-Hospital Healthcare Utilization, Outcomes, and Costs in Pre-Hospital-Adjudicated Low-Risk Chest-Pain Patients.

机构信息

Department of Cardiology, Isala Hospital, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.

Regional Ambulance Service IJsselland, Zwolle, The Netherlands.

出版信息

Appl Health Econ Health Policy. 2019 Dec;17(6):875-882. doi: 10.1007/s40258-019-00502-6.

DOI:10.1007/s40258-019-00502-6

PMID:31388939

Abstract

BACKGROUND

There is increasing evidence that in patients presenting with acute chest pain, pre-hospital triage can accurately identify low-risk patients. It is, however, still unclear which diagnostics are performed in pre-hospital-adjudicated low-risk patients and what the contribution is of those diagnostic results in the healthcare process.

OBJECTIVES

The aim of this study was to quantify healthcare utilization, costs, and outcomes in pre-hospital-adjudicated low-risk chest-pain patients, and to extrapolate to total costs in the Netherlands.

METHODS

This was a prospective cohort study including 700 patients with suspected non-ST-elevation acute coronary syndrome in which pre-hospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as a pre-hospital HEART score ≤ 3. Data on (results of) hospital diagnostics, costs, and discharge diagnosis were collected.

RESULTS

A total of 172 (25%) patients were considered as low risk. Of these low-risk patients, the mean age was 54 years, 52% were male, and 84% of patients were discharged within 12 h. Repeated electrocardiography and routine laboratory measurements, including cardiac markers, were performed in all patients. Chest X-ray was performed in 61% and echocardiography in 11% of patients. After additional diagnostics, two patients (1.2%) were diagnosed as non-ST-elevation myocardial infarction and two patients (1.2%) as unstable angina. Other diagnoses were atrial fibrillation (n = 1) and acute pancreatitis/cholecystitis (n = 2); all other patients had non-specific/non-acute discharge diagnoses. Mean in-hospital costs per patient were €1580. The estimated yearly acute healthcare cost in low-risk chest-pain patients in the Netherlands is €30,438,700.

CONCLUSION

In low-risk chest-pain patients according to pre-hospital risk assessment, acute healthcare utilization and costs are high, with limited added value. Possibly, if a complete risk assessment can be performed by ambulance paramedics, acute hospitalization of the majority of low-risk patients is not necessary, which can lead to substantial cost reduction.

TRIAL ID

Dutch Trial Register [http://www.trialregister.nl]: trial number 4205.

摘要

背景

越来越多的证据表明，在出现急性胸痛的患者中，院前分诊可以准确识别低危患者。然而，目前仍不清楚在院前判定为低危的患者中进行了哪些诊断，以及这些诊断结果在医疗过程中的贡献是什么。

目的

本研究的目的是量化院前判定为低危胸痛患者的医疗保健利用、成本和结局，并推断出荷兰的总费用。

方法

这是一项前瞻性队列研究，纳入了 700 例疑似非 ST 段抬高型急性冠状动脉综合征患者，由护理人员使用 HEART 评分进行院前风险分层。低危定义为院前 HEART 评分≤3。收集了医院诊断、成本和出院诊断的数据。

结果

共有 172 例（25%）患者被认为是低危。这些低危患者的平均年龄为 54 岁，52%为男性，84%的患者在 12 小时内出院。所有患者均进行了重复心电图和常规实验室检查，包括心脏标志物。61%的患者进行了胸部 X 光检查，11%的患者进行了超声心动图检查。在进行了额外的诊断后，有 2 例（1.2%）患者被诊断为非 ST 段抬高型心肌梗死，2 例（1.2%）患者被诊断为不稳定型心绞痛。其他诊断包括心房颤动（n=1）和急性胰腺炎/胆囊炎（n=2）；所有其他患者均为非特异性/非急性出院诊断。每位患者的平均住院费用为 1580 欧元。荷兰低危胸痛患者的急性医疗保健年度费用估计为 30438700 欧元。