{
  "abstract": "BackgroundThe practice of hospitalizing emergency department (ED) patients with chest pain after ruling out acute myocardial infarction (AMI) varies widely. The long-term outcome and cost implications of this variation are uncertain.\n\nMethodsAnalyzing 2007-2021 claims from a national commercial insurer, we identified 223,569 adults ([≥]18 years) ED visits with a principal diagnosis of chest pain without major secondary cardiopulmonary diagnoses, seen by 19,001 clinicians in 2,273 EDs. Within each ED, clinicians with the highest and lowest terciles of risk-adjusted hospitalization rates were classified as high-versus low-admitting. Primary outcomes were 30-and 180-day subsequent AMI hospitalizations. Secondary outcomes included 7-day cardiac testing, 30-day coronary intervention, and 30-day total and out-of-pocket costs. We estimated adjusted rate ratios (aRRs) and relative cost differences using generalized estimating equations, adjusting for patient and visit characteristics.\n\nResultsPatients had a mean age of 48.6 years, and 53.9% were female; measured characteristics were similar between groups. Compared with low-admitting clinicians, visits to high-admitting clinicians had higher 7-day cardiac testing (13.1% vs 10.8%; aRR 1.22, 95% CI 1.17-1.27) and 30-day coronary interventions (4.3% vs 3.8%; aRR 1.16, 95% CI 1.09-1.23). AMI hospitalization did not differ at 30 days (0.60% vs 0.60%; aRR 1.00, 95% CI 0.84-1.15) or 180 days (0.85% vs 0.87%; aRR 0.97, 95% CI 0.85-1.10). Thirty-day total costs were higher after visits to high-admitting clinicians (relative change 11.3%, 95% CI 8.8-13.8), and out-of-pocket costs [≥]$1,000 were more common (32.0% vs 29.6%; relative change 8.2%, 95% CI 6.1-10.3).\n\nConclusionsHigher clinician hospitalizing tendency for ED chest pain is associated with greater downstream testing, more coronary interventions, and higher costs without lower short-or intermediate-term AMI risk. Reducing marginal admissions among high-admitting clinicians may decrease spending and practice variation with minimal impact on AMI outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "UCSF"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "S.-C. Chou"
    },
    {
      "name": "R. Y. Hsia"
    },
    {
      "name": "F. Zhang"
    },
    {
      "name": "J. F. Wharam"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/66dazsagf5wg9.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.02.26364626",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.02.26364626v1.full",
  "id": "66dazsagf5wg9",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.02.26364626v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "emergency medicine"
    ],
    [
      "openalex",
      "2711|Emergency and Acute Care Studies"
    ]
  ],
  "openalex": "W7220470299",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.02.26364626v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-02",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/66dazsagf5wg9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:06Z",
      "native_id": "10.64898/2026.10.02.26364626",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.02.26364626v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:emergency medicine",
      "subfield": "general"
    }
  ],
  "title": "Chest Pain Hospitalizations: How Varying Emergency Clinician Tendencies Impact Care, Outcomes, and Costs",
  "title_text": "Chest Pain Hospitalizations: How Varying Emergency Clinician Tendencies Impact Care, Outcomes, and Costs",
  "type": "preprint",
  "updated_at": "2026-10-30T12:20:06Z",
  "url": "https://research.draconitic.com/paper/66dazsagf5wg9",
  "venue": "medRxiv",
  "versions": []
}