Emergency care For you, or with you? Erik P. Hess MD MSc Professor of Emergency Medicine University of Alabama at Birmingham @ErikHessMD October 31, 2018 #PCORI2018
COI Disclosures Erik P. Hess MD MSc • Nothing to disclose 2
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Does the tool work? A multicenter randomized trial 6
How would you get in the study? 7
Who was included? • Primary complaint of chest pain • Being considered for hospital admission for cardiac stress testing • Not included : ischemic ECG, elevated troponin, known coronary artery disease, recent cocaine use 8
What outcomes did we measure? • Patient-centered: knowledge, engagement, acceptability • Clinical endpoints • Safety: Major Adverse Cardiac Events • Resource use: Rates of hospital admission and stress testing 9
What did we find? (n=898) Outcome Change ↑ Patient knowledge ↑ Patient engagement ↓ (16%) Admitted for stress testing ↓ (8%) Stress testing within 30 days ↑ Provider experience ↑ Outpatient follow-up ↔ Safety Hess, Montori et al. BMJ 2016
Limitations and Next Steps • Limited power to definitively demonstrate safety • Effectiveness outside randomized trial unknown • Next step: Dissemination and Implementation 11
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Thank You! @ErikHessMD 13
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