1 / 27

Involving Patients with Low Risk Chest Pain in Discharge Decisions: A Multicenter Trial

This study aimed to test the effectiveness of the Chest Pain Choice decision aid in a pragmatic multicenter randomized controlled trial. The study found that the decision aid increased patient knowledge and engagement, safely decreased resource use, and was acceptable to both patients and clinicians.

jdeems
Download Presentation

Involving Patients with Low Risk Chest Pain in Discharge Decisions: A Multicenter Trial

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Involving Patients with Low Risk Chest Pain in Discharge Decisions: A Multicenter Trial Erik P. Hess MD MSc

  2. Background • Chest Pain 2nd most common complaint in US EDs • 1.5% ACS missed • Stress testing frequently obtained in low risk patients • False positive test results, unnecessary procedures, cost

  3. Evidence synthesis (ACS risk estimation tool) Observations clinical encounter Initial prototype Designers Study team Patients Clinicians Stakeholders Field testing Modified prototype Final Decision Aid Evaluation (trial)

  4. Chest Pain Choice Pilot Trial(n=201) Hess, Kline, Stiell et al. Circulation CQO 2012

  5. Objective Test the effectiveness of Chest Pain Choice in a pragmatic multicenter RCT

  6. Methods

  7. Design Patient level RCT Allocation concealed by password-protected, web-based randomization scheme Dynamic randomization 1:1 ratio

  8. Eligibility criteria • Inclusion • Adults with chest pain considered for EDOU admission for stress testing or coronary CTA • Exclusion • Ischemic ECG • Elevated troponin • Known CAD • Cocaine use within 72 hours • Unable to provide informed consent or use DA

  9. Outcome measures • Decision quality Patient knowledge** Degree of patient participation (OPTION scale) Acceptability • CV endpoints Safety: 30-day MACE Resource use • Admitted to EDOU for stress testing or coronary CT • 30-day rate of stress testing/coronary CT

  10. Results

  11. Baseline characteristics

  12. Knowledge and Engagement

  13. Decision aid acceptability (patient) Control Intervention P=0.004 P=0.01 %

  14. Decision aid acceptability (clinician) Control Intervention P<0.001 P<0.001 %

  15. Safety

  16. Resource Use Control Intervention P<0.001 % P=0.12

  17. Conclusions Chest Pain Choice • Increased patient knowledge and engagement • Safely decreased resource use • Acceptable to patients and clinicians Next Step: Implementation

  18. E Hess, J Hollander, J Schaeffer, J Kline, C Torres, D Diercks, R Jones, N Shah, J Inselman, J Herrin, A Castaneda-Guarderas, V. Montori Knowledge and Evaluation Research Unit Mayo Clinic MN

More Related