ALTERNATIVE APPROACHES FOR EVALUATION OF FEVER IN IDUS

评估注射吸毒者发热的替代方法

• 批准号: 2653451
• 负责人: RICHARD E ROTHMAN
• 金额: $ 6.25万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-09-30 至 1999-03-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2653451
• 关键词: behavioral /social science research tag; cardiovascular disorder diagnosis; clinical research; diagnosis design /evaluation; diagnostic tests; endocarditis; health economics; health services research tag; hospital length of stay; human subject; intravenous drug abuse

There are over 1 million persons in the United States who are intravenous drug users (IDUs). The epidemic has principally struck the minority inner-city population, with women affected nearly as frequently as men. Provision of medical services to IDUs places a significant strain on public resources, as close to 50 percent of this population lack any type of health insurance. Development of efficient diagnostic and management strategies for the common medical complications which occur in this group of patients have lagged behind that for other sectors of the population. Infective endocarditis (E) is one of the most serious medical complications associated with IDU, with significant morbidity and mortality occurring in unrecognized cases. Presenting clinical features associated with IE have been difficult to define. Because fever is found to occur in nearly 98 percent of cases of IE in IDUs, current practice is to hospitalize all febrile IDUs for further evaluation, testing and observation. Although the true incidence (approximately 3,000-7,500) of IE in IDUs is relatively low, nearly 10 times as many patients in whom the diagnosis is being considered are hospitalized each year. This represents a significant financial burden to the health care system. To date, there have been no studies which have attempted to develop alternative approaches to inpatient diagnosis in patients in whom the disease is being considered. The objectives of this study are: (1) To design an algorithm which uses clinical information and diagnostic adjuncts available during ED evaluation to identify which febrile IDUs are most likely to have IE, or are likely to develop complications that require hospitalization. IDUs with fever will be admitted from the ED to an in-patient unit arranged to simulate an ED observation unit. (2) To determine the potential costs savings associated with alternative management strategies (such as outpatient testing and follow-up, or ED based rapid evaluation) for those IDUs who have low risk for either of the above. Results from this pilot investigation will be used to design a larger prospective investigation to test the new clinical decision algorithm. The study will provide the first description of early use of diagnostic testing and clinical assessment applied in conjunction towards rapid evaluation of the large population of febrile IDUs. Implementation of this algorithm has the potential to save the health care system hundreds of millions of dollars each year in unnecessary hospital costs.

美国有超过 100 万人 静脉吸毒者 (IDU)。此次疫情主要打击的是 少数族裔内城区人口，其中女性受影响的频率几乎相同 作为男人。 向注射吸毒者提供医疗服务造成巨大压力 近 50% 的人口缺乏公共资源 健康保险的类型。 开发高效的诊断和 发生的常见医疗并发症的管理策略 在这组患者中，落后于其他部门的患者 人口。 感染性心内膜炎（E）是最严重的医学疾病之一 与 IDU 相关的并发症，具有显着的发病率和 死亡发生在未被识别的病例中。 呈现临床特征 与 IE 的关联一直很难定义。 因为发现发烧 注射吸毒者中近 98% 的 IE 病例都会发生，目前的做法是 将所有发热注射吸毒者住院进行进一步评估、检测和 观察。 尽管真实发生率（大约 3,000-7,500） 注射吸毒者中的 IE 相对较低，几乎是吸毒者的 10 倍 每年都会考虑诊断并住院。 这 给医疗保健系统带来了巨大的经济负担。 到 迄今为止，还没有任何研究试图开发 住院诊断的替代方法 正在考虑疾病。 本研究的目标是： (1) 设计一种算法 急诊科期间提供的临床信息和诊断辅助手段 评估以确定哪些发热的注射吸毒者最有可能患有 IE，或者 可能会出现需要住院治疗的并发症。 注射吸毒者 发烧者将从急诊室转入已安排的住院病房 模拟 ED 观察单元。 (2) 确定潜在成本 与替代管理策略（例如 门诊检测和随访，或基于急诊科的快速评估） 上述任一情况风险较低的注射吸毒者。 本次试点的结果 调查将用于设计更大规模的前瞻性调查 测试新的临床决策算法。 该研究将首次描述早期使用诊断 测试和临床评估结合应用以实现快速 对大量发热注射吸毒者的评估。 实施 该算法有可能为医疗保健系统节省数百 每年不必要的住院费用达数百万美元。