Shared Decision Making in the Emergency Department: Chest Pain Choice Trial
| Status: | Completed |
|---|---|
| Conditions: | Angina, Cardiology, Hospital |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/8/2018 |
| Start Date: | October 2013 |
| End Date: | December 2015 |
Shared Decision Making in the Emergency Department: The Chest Pain Choice Trial
Our long-term goal is to promote evidence-based patient-centered evaluation in the acute
setting to more closely tailor testing to disease risk. To compare the use of risk
stratification tools with usual clinical approaches to treatment selection or administration,
we propose the following:
1. Test if Chest Pain Choice safely improves validated patient-centered outcome measures in
a pragmatic parallel patient randomized trial.
Hypothesis: The intervention will significantly increase patient knowledge, engagement,
and satisfaction with no increase in adverse events.
2. Test if the decision aid has an effect on healthcare utilization within 30 days after
enrollment.
Hypothesis: The intervention will significantly reduce the rate of hospital admission, rate
of cardiac testing, and total healthcare utilization.
setting to more closely tailor testing to disease risk. To compare the use of risk
stratification tools with usual clinical approaches to treatment selection or administration,
we propose the following:
1. Test if Chest Pain Choice safely improves validated patient-centered outcome measures in
a pragmatic parallel patient randomized trial.
Hypothesis: The intervention will significantly increase patient knowledge, engagement,
and satisfaction with no increase in adverse events.
2. Test if the decision aid has an effect on healthcare utilization within 30 days after
enrollment.
Hypothesis: The intervention will significantly reduce the rate of hospital admission, rate
of cardiac testing, and total healthcare utilization.
Inclusion Criteria:
1. 18+ years of age (at least 18).
2. Admitted to emergency department for chest pain.
3. Being considered by the treating clinician for admission for cardiac testing.
Exclusion Criteria:
1. Ischemic changes on the electrocardiogram not known to be old as determined by the
treating clinician in real time.
2. Elevated cardiac troponin (cTn) above the 99th percentile reference limit.
3. Known coronary artery disease as defined by consensus guidelines on risk
stratification studies for emergency department patients with potential acute coronary
syndrome (≥ 50% stenosis on cardiac catheterization; prior electrocardiographic
changes indicative of ischemia, e.g., ST-segment depression, T-wave inversion, or left
bundle branch block; perfusion defects or wall motion abnormalities on previous
exercise, pharmacological, or rest imaging studies; previous documentation of acute
myocardial infarction; or, if no records are available, patient self-report of
coronary artery disease).
4. Cocaine use within the previous 72 hours by clinician history.
5. Pregnancy.
6. Referral to the emergency department by a personal physician for admission.
7. Patients who indicate that a hospital different than the site hospital is his or her
"hospital of choice" in the event of a return emergency department visit.
8. Patients undergoing medical clearance for a detox center or any involuntary court or
magistrate order.
9. Homelessness, out-of-town residence or other condition known to preclude follow-up.
10. Patients in police custody or currently incarcerated individuals.
11. Patients who have, in their clinician's best judgment, major communication barriers
such as visual or hearing impairment or dementia that would compromise their ability
to give written informed consent (or use the decision aid).
We found this trial at
5
sites
Mayo Clinic Mayo Clinic's campus in Arizona provides medical care for thousands of people from...
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Thomas Jefferson University We are dedicated to the health sciences and committed to educating professionals,...
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University of California-Davis As we begin our second century, UC Davis is poised to become...
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