| The purpose of this study was to explore the costs and outcomes of monitoring patients with chest pain in three alternative care sites (emergency department, outpatient observation unit, inpatient cardiology unit) in a military medical treatment facility (MTF) using the Reynolds and Gaspari framework. Costs were measured on the basis of nursing personnel salaries and patient monitoring costs (diagnostic testing, consultants, and length of stay). Outcome variables included: (a) percent of MI diagnosis in monitored patients, (b) 30-day recidivism rate in monitored patients who returned with a complaint of chest pain, (c) length of stay, (d) type and number of diagnostic tests ordered by physician specialty, (e) length of stay for patients enrolled in TRICARE (military health maintenance organization) and not enrolled in TRICARE, and (f) differences in demographic characteristics and number of co-morbidities in patients diagnosed with MI and patients ruled-out for MI. There were significant differences in length of stay and costs among the three alternative monitoring sites. This study provided evidence that, for the extended evaluation of patients with chest pain, the outpatient observation unit had significantly lower costs and similar patient outcomes when compared with the inpatient cardiology unit. (Abstract shortened by UMI.)... |
