Standardizing Emergency Work-ups Around Risk Data (STEWARD)
11. august 2020 opdateret af: Kaiser Permanente
Standardizing Emergency Work-ups Around Risk Data (STEWARD): The CREST Network Chest Pain Project
Chest pain is the second leading reason for emergency department (ED) visits in the United States.
Resource utilization for this ED subpopulation is particularly high, in part due to a dearth of accepted standardized clinical approaches and general overestimation of risk on the part of both providers and patients.
This prospective observational cohort study seeks to address this issue by providing externally validated risk scores for major adverse cardiac events using a web-based clinical decision support platform (RISTRA) embedded within the electronic health record at 13 Kaiser Permanente Northern California (KPNC) EDs over a 12-month period.
The decision support will provide risk estimates specific to the KPNC patient population.
This studies hypothesis is that the provision of more accurate risk estimation for major adverse cardiac events will improve informed decision making by both providers and patients, resulting in less provocative testing and lower ED lengths of stay amongst low risk patients, as well as improving medical management among non-low risk patients and decreasing future rates of major adverse cardiac events.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Undersøgelsestype
Observationel
Tilmelding (Faktiske)
13419
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
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California
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Antioch, California, Forenede Stater, 94531
- Kaiser Permanente Antioch Emergency Department
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Fremont, California, Forenede Stater, 94538
- Kaiser Permanente Fremont Emergency Department
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Oakland, California, Forenede Stater, 94611
- Kaiser Permanente Oakland Emergency Department
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Richmond, California, Forenede Stater, 94801
- Kaiser Permanente Richmond Emergency Department
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Roseville, California, Forenede Stater, 95661
- Kaiser Permanente Roseville Emergency Department
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Sacramento, California, Forenede Stater, 95823
- Kaiser Permanente South Sacramento Emergency Department
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Sacramento, California, Forenede Stater, 95825
- Kaiser Permanente Sacramento Emergency Department
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San Francisco, California, Forenede Stater, 94115
- Kaiser Permanente San Francisco Emergency Department
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San Leandro, California, Forenede Stater, 94577
- Kaiser Permanente San Leandro Emergency Department
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San Rafael, California, Forenede Stater, 94903
- Kaiser Permanente San Rafael Emergency Department
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South San Francisco, California, Forenede Stater, 94080
- Kaiser Permanente South San Francisco Emergency Department
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Walnut Creek, California, Forenede Stater, 94596
- Kaiser Permanente Walnut Creek Emergency Department
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Deltagelseskriterier
Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.
Berettigelseskriterier
Aldre berettiget til at studere
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Prøveudtagningsmetode
Ikke-sandsynlighedsprøve
Studiebefolkning
Adult patients presenting to KPNC emergency departments with above elgibilty criteria
Beskrivelse
Inclusion Criteria:
- Emergency department chief complaint of chest pain or chest discomfort
- Clinical concern for possible cardiac ischemia
Studieplan
Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Observationsmodeller: Kohorte
- Tidsperspektiver: Fremadrettet
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Major adverse cardiac event (MACE)
Tidsramme: 12 months
|
A composite outcome of either acute myocardial infarction, cardiac arrest, malignant arrhythmia, cardiac-related mortality
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12 months
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Provocative and anatomic cardiac testing rates
Tidsramme: 12 months
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Treadmill stress test, myocardial perfusion imaging, stress echocardiography, CT coronary angiography, catheter-based coronary angiography
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12 months
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Emergency department length of stay
Tidsramme: 12 months
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Total hours spent in the emergency department among study eligible patients
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12 months
|
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Hospital admission rate
Tidsramme: 12 months
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Percentage of hospital admissions among study eligible patients
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12 months
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Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Publikationer og nyttige links
Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.
Generelle publikationer
- Sabbatini AK, Nallamothu BK, Kocher KE. Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings. Health Aff (Millwood). 2014 Sep;33(9):1655-63. doi: 10.1377/hlthaff.2013.1318.
- Venkatesh AK, Dai Y, Ross JS, Schuur JD, Capp R, Krumholz HM. Variation in US hospital emergency department admission rates by clinical condition. Med Care. 2015 Mar;53(3):237-44. doi: 10.1097/MLR.0000000000000261.
- Newman DH, Ackerman B, Kraushar ML, Lederhandler MH, Masri A, Starikov A, Tsao DT, Meyers HP, Shah KH. Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary Syndromes. Ann Emerg Med. 2015 Jul;66(1):13-8, 18.e1. doi: 10.1016/j.annemergmed.2015.01.027. Epub 2015 Mar 4.
- Than MP, Pickering JW, Aldous SJ, Cullen L, Frampton CM, Peacock WF, Jaffe AS, Goodacre SW, Richards AM, Ardagh MW, Deely JM, Florkowski CM, George P, Hamilton GJ, Jardine DL, Troughton RW, van Wyk P, Young JM, Bannister L, Lord SJ. Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain: A Pragmatic Randomized Controlled Trial Embedded Within Practice. Ann Emerg Med. 2016 Jul;68(1):93-102.e1. doi: 10.1016/j.annemergmed.2016.01.001.
- Mahler SA, Riley RF, Hiestand BC, Russell GB, Hoekstra JW, Lefebvre CW, Nicks BA, Cline DM, Askew KL, Elliott SB, Herrington DM, Burke GL, Miller CD. The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge. Circ Cardiovasc Qual Outcomes. 2015 Mar;8(2):195-203. doi: 10.1161/CIRCOUTCOMES.114.001384. Epub 2015 Mar 3.
- Mark DG, Huang J, Ballard DW, Kene MV, Sax DR, Chettipally UK, Lin JS, Bouvet SC, Cotton DM, Anderson ML, McLachlan ID, Simon LE, Shan J, Rauchwerger AS, Vinson DR, Reed ME; Kaiser Permanente CREST Network Investigators [Link]. Graded Coronary Risk Stratification for Emergency Department Patients With Chest Pain: A Controlled Cohort Study. J Am Heart Assoc. 2021 Nov 16;10(22):e022539. doi: 10.1161/JAHA.121.022539. Epub 2021 Nov 6.
- Mark DG, Huang J, Kene MV, Sax DR, Cotton DM, Lin JS, Bouvet SC, Chettipally UK, Anderson ML, McLachlan ID, Simon LE, Shan J, Rauchwerger AS, Vinson DR, Ballard DW, Reed ME; Kaiser Permanente CREST Network Investigators. Prospective Validation and Comparative Analysis of Coronary Risk Stratification Strategies Among Emergency Department Patients With Chest Pain. J Am Heart Assoc. 2021 Apr 6;10(7):e020082. doi: 10.1161/JAHA.120.020082. Epub 2021 Mar 31.
Datoer for undersøgelser
Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.
Studer store datoer
Studiestart (Faktiske)
1. juli 2018
Primær færdiggørelse (Faktiske)
31. december 2019
Studieafslutning (Faktiske)
1. juni 2020
Datoer for studieregistrering
Først indsendt
13. september 2017
Først indsendt, der opfyldte QC-kriterier
13. september 2017
Først opslået (Faktiske)
18. september 2017
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
12. august 2020
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
11. august 2020
Sidst verificeret
1. august 2020
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- CN-16-2648
Plan for individuelle deltagerdata (IPD)
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Ingen
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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