Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain

Study protocol for a multicenter randomized trial

Ryan T. Anderson, Victor M. Montori, Nilay D. Shah, Henry H. Ting, Laurie J. Pencille, Michel Demers, Jeffrey A. Kline, Deborah B. Diercks, Judd E. Hollander, Carlos A. Torres, Jason T. Schaffer, Jeph Herrin, Megan Branda, Annie Leblanc, Erik P. Hess

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization. Methods/Design: This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. Discussion: This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs. Trial registration: NCT01969240.

Original languageEnglish (US)
Article number166
JournalTrials
Volume15
Issue number1
DOIs
StatePublished - May 10 2014

Fingerprint

Decision Support Techniques
Chest Pain
Multicenter Studies
Hospital Emergency Service
Delivery of Health Care
Acute Coronary Syndrome
Decision Making
Observation
Patient Participation
Video Recording
Hospital Records
Electronic Health Records
Patient Satisfaction
Telephone
Emotions

Keywords

  • Acute coronary syndrome
  • Acute myocardial infarction
  • Chest pain
  • Emergency department
  • Healthcare utilization
  • Shared decision-making
  • Unstable angina

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain : Study protocol for a multicenter randomized trial. / Anderson, Ryan T.; Montori, Victor M.; Shah, Nilay D.; Ting, Henry H.; Pencille, Laurie J.; Demers, Michel; Kline, Jeffrey A.; Diercks, Deborah B.; Hollander, Judd E.; Torres, Carlos A.; Schaffer, Jason T.; Herrin, Jeph; Branda, Megan; Leblanc, Annie; Hess, Erik P.

In: Trials, Vol. 15, No. 1, 166, 10.05.2014.

Research output: Contribution to journalArticle

Anderson, RT, Montori, VM, Shah, ND, Ting, HH, Pencille, LJ, Demers, M, Kline, JA, Diercks, DB, Hollander, JE, Torres, CA, Schaffer, JT, Herrin, J, Branda, M, Leblanc, A & Hess, EP 2014, 'Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain: Study protocol for a multicenter randomized trial', Trials, vol. 15, no. 1, 166. https://doi.org/10.1186/1745-6215-15-166
Anderson, Ryan T. ; Montori, Victor M. ; Shah, Nilay D. ; Ting, Henry H. ; Pencille, Laurie J. ; Demers, Michel ; Kline, Jeffrey A. ; Diercks, Deborah B. ; Hollander, Judd E. ; Torres, Carlos A. ; Schaffer, Jason T. ; Herrin, Jeph ; Branda, Megan ; Leblanc, Annie ; Hess, Erik P. / Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain : Study protocol for a multicenter randomized trial. In: Trials. 2014 ; Vol. 15, No. 1.
@article{1fa5fc22533048969118dee9873afc23,
title = "Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain: Study protocol for a multicenter randomized trial",
abstract = "Background: Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization. Methods/Design: This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. Discussion: This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs. Trial registration: NCT01969240.",
keywords = "Acute coronary syndrome, Acute myocardial infarction, Chest pain, Emergency department, Healthcare utilization, Shared decision-making, Unstable angina",
author = "Anderson, {Ryan T.} and Montori, {Victor M.} and Shah, {Nilay D.} and Ting, {Henry H.} and Pencille, {Laurie J.} and Michel Demers and Kline, {Jeffrey A.} and Diercks, {Deborah B.} and Hollander, {Judd E.} and Torres, {Carlos A.} and Schaffer, {Jason T.} and Jeph Herrin and Megan Branda and Annie Leblanc and Hess, {Erik P.}",
year = "2014",
month = "5",
day = "10",
doi = "10.1186/1745-6215-15-166",
language = "English (US)",
volume = "15",
journal = "Trials",
issn = "1745-6215",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Effectiveness of the chest pain choice decision aid in emergency department patients with low-risk chest pain

T2 - Study protocol for a multicenter randomized trial

AU - Anderson, Ryan T.

AU - Montori, Victor M.

AU - Shah, Nilay D.

AU - Ting, Henry H.

AU - Pencille, Laurie J.

AU - Demers, Michel

AU - Kline, Jeffrey A.

AU - Diercks, Deborah B.

AU - Hollander, Judd E.

AU - Torres, Carlos A.

AU - Schaffer, Jason T.

AU - Herrin, Jeph

AU - Branda, Megan

AU - Leblanc, Annie

AU - Hess, Erik P.

PY - 2014/5/10

Y1 - 2014/5/10

N2 - Background: Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization. Methods/Design: This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. Discussion: This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs. Trial registration: NCT01969240.

AB - Background: Chest pain is the second most common reason patients visit emergency departments (EDs) and often results in very low-risk patients being admitted for prolonged observation and advanced cardiac testing. Shared decision-making, including educating patients regarding their 45-day risk for acute coronary syndrome (ACS) and management options, might safely decrease healthcare utilization. Methods/Design: This is a protocol for a multicenter practical patient-level randomized trial to compare an intervention group receiving a decision aid, Chest Pain Choice (CPC), to a control group receiving usual care. Adults presenting to five geographically and ethnically diverse EDs who are being considered for admission for observation and advanced cardiac testing will be eligible for enrollment. We will measure the effect of CPC on (1) patient knowledge regarding their 45-day risk for ACS and the available management options (primary outcome); (2) patient engagement in the decision-making process; (3) the degree of conflict patients experience related to feeling uninformed (decisional conflict); (4) patient and clinician satisfaction with the decision made; (5) the rate of major adverse cardiac events at 30 days; (6) the proportion of patients admitted for advanced cardiac testing; and (7) healthcare utilization. To assess these outcomes, we will administer patient and clinician surveys immediately after each clinical encounter, obtain video recordings of the patient-clinician discussion, administer a patient healthcare utilization diary, analyze hospital billing records, review the electronic medical record, and conduct telephone follow-up. Discussion: This multicenter trial will robustly assess the effectiveness of a decision aid on patient-centered outcomes, safety, and healthcare utilization in low-risk chest pain patients from a variety of geographically and ethnically diverse EDs. Trial registration: NCT01969240.

KW - Acute coronary syndrome

KW - Acute myocardial infarction

KW - Chest pain

KW - Emergency department

KW - Healthcare utilization

KW - Shared decision-making

KW - Unstable angina

UR - http://www.scopus.com/inward/record.url?scp=84901396882&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901396882&partnerID=8YFLogxK

U2 - 10.1186/1745-6215-15-166

DO - 10.1186/1745-6215-15-166

M3 - Article

VL - 15

JO - Trials

JF - Trials

SN - 1745-6215

IS - 1

M1 - 166

ER -