Underuse and overuse of diagnostic testing for coronary artery disease in patients presenting with new-onset chest pain.
To determine the extent of overuse and underuse of diagnostic testing for coronary artery disease and whether the socioeconomic status, health insurance, gender, and race/ethnicity of a patient influences the use of diagnostic tests.
SUBJECTS AND METHODS
We identified patients who presented with new-onset chest pain not due to myocardial infarction at one of five Los Angeles-area hospital emergency departments between October 1994 and April 1996.
Explicit criteria for diagnostic testing were developed using the RAND/University of California, Los Angeles, expert panel method.
They were applied to data collected by medical record review and patient questionnaire.
Of the 356 patients, 181 met necessity criteria for diagnostic cardiac testing.
Of these, 40 (22%) failed to receive necessary tests.
Only 7 (3%) of the 215 patients who received some form of cardiac testing had tests that were judged to be inappropriate.
Underuse was significantly more common in patients with only a high school education (30% vs 15% for those with some college, P=0.02) and those without health insurance (34% vs 15% of insured patients, P=0.01).
In a multivariate logistic regression model, only the lack of a post-high school education was a significant predictor of underuse (odds ratio 2.2,95% confidence interval 1.0 to 4.4).
Among patients with new-onset chest pain, underuse of diagnostic testing for coronary artery disease was much more common than overuse. (...)
Mots-clés Pascal : Douleur, Thorax, Questionnaire, Statut socioéconomique, Race, Assurance maladie, Epreuve effort, Diagnostic, Prévalence, Cardiopathie coronaire, Evaluation, Homme, Critère décision, Traumatisme, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Pain, Thorax, Questionnaire, Socioeconomic status, Race, Health insurance, Exercise tolerance test, Diagnosis, Prevalence, Coronary heart disease, Evaluation, Human, Decision criterion, Trauma, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0234297
Code Inist : 002B12A03. Création : 16/11/1999.