Grant Number: R01 HS10280
RFA/PA:
PI Name: SELKER, HARRY
Project Title: Local vs Referral Care: Choice by Mathematical Equipoise

Abstract:

SELKER, HARRY P
NEW ENGLAND MEDICAL CENTER, BOSTON, MA
LOCAL VS REFERRAL CARE: CHOICE BY MATHEMATICAL EQUIPOISE
R01 HS10280-01A1
07/01/00
Building on previous work done by the investigators, this study proposes to
develop a mathematical model that would assist emergency medical teams
responding to an acute myocardial infarction in determining whether the
additional time required to transport a patient to a high volume PTCA cardiac
center is justified given the predicted difference in outcomes between
treatment at a community hospital and treatment at a cardiac center. The
investigators argue that having such a tool available would make it possible to
ethically conduct an effectiveness trial of thrombolytic therapy versus PTCA in
the range of U.S. hospitals.

The specific aims of the study are: (1) to create a mathematical model that
estimates the time delay that is justified to transport a patient with AMI to a
cardiac center; (2) to explore the clinical and policy implications of
patient-specific predictions and the mathematical model on the choice of
treatments and hospital settings; (3) to incorporate the mathematical models
into current ECG machines that assess whether a patient is a likely candidate
for reperfusion; (4) to plan a trial of referral vs. local care for patients
with AMI.

The investigators will begin by assembling a large database that combines
clinical trial and registry data. The data bases include: the investigators
Thrombolytic Predictive Instrument (TPI) trial, the National Registry of
Myocardial Infarction (NMRI), the Primary Angioplasty in Myocardial Infarction
(PAMI) trials, and the Myocardial Infarction Triage and Intervention (MITI)
registry. These data bases will be used to model mortality outcomes for
patients with AMI treated with PTCA, to explore the clinical and policy
implications of patient selection, and to estimate the "time interval of
mathematical equipoise" (TIME) within which transport delay to obtain a PTCA at
a cardiac center is justified. The investigators will develop and test an
enhanced TPI including programming a self-interpreting electrocardiograph.


Fiscal Year: 2002
Department: TUFTS MEDICAL CENTER
Project Start: 05/07/2001
Project End: 03/31/2004
IRG: HQER