A survey of chest pain centers within the United States from a resource dependence and transaction cost perspective
Using the resource dependence and transaction cost theories as conceptual frameworks, this national study investigated the organizational characteristics and environmental factors that appear to compel a health care facility to develop a chest pain center. Despite the benefits of such units, the literature has not examined the precipitating conditions that motivate hospitals to develop chest pain centers.
A nonexperimental, cross-sectional survey design was employed in this research study. The survey was mailed to 587 nonfederal, acute care general hospitals that operated an emergency department. These facilities were randomly selected from the American Hospital Association's database of health care facilities (N = 4,146). The response rate was 63.7%. Of those responding hospitals, 10.6% or 39 facilities had chest pain centers. The profile of the average responding hospital that had a unit admitted more than 4,250 patients per year, had more than 125 inpatient beds, and was located in a metropolitan statistical area (MSA). Additionally, these health care facilities offered more than 38 health care services to its community, employed clinical pathways or guidelines, and were located in counties that had competing health care facilities as well as chest pain centers. Furthermore, statistical evidence revealed that facility's affiliation with a health maintenance organization (HMO) or preferred provider organization (PPO), membership in a health care system, or ownership did not affect the decision to develop a chest pain center. These centers are modeled after the coronary care units and provide medical interventions for a patient with chest pain. Their ultimate success will be established when they are recognized as contributing to a decrease in the number of deaths associated with coronary heart disease.