 |
|
Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease
Results From a Quality Improvement Project
Jane Brock, MD, MSPH;
Angela Sauaia, MD, PhD;
Dennis Ahnen, MD;
William Marine, MD, MPH;
William Schluter, MD, MSPH;
Beth R. Stevens, MS;
Jeanne D. Scinto, PhD, MPH;
Herbert Karp, MD;
Dale Bratzler, DO, MPH
JAMA. 2001;286:1985-1993.
Context Since publication in 1994 of guidelines for management of peptic ulcer disease (PUD), trends in physician practice and outcomes related to guideline application have not been evaluated.
Objectives To describe changes in process of care that occurred in a quality improvement program for patients hospitalized with PUD and to evaluate associations between in-hospital treatment of PUD and 1-year rehospitalization for PUD and mortality in a subset of these patients.
Design, Setting, and Patients Cohort study of 4292 sequential Medicare beneficiaries hospitalized at acute care hospitals with a principal diagnosis of PUD in 5 states (Colorado, Georgia, Connecticut, Oklahoma, and Virginia) in 1995 (baseline) and 1997 (remeasurement); outcomes were evaluated for 752 patients in Colorado.
Main Outcome Measures Changes in rates of screening for Helicobacter pylori infection, treatment for H pylori infection, screening for nonsteroidal anti-inflammatory drug (NSAID) use, counseling about NSAID use; outcomes included rehospitalization for PUD and all-cause mortality within 1 year of discharge in Colorado.
Results Screening for H pylori infection increased significantly (12%-19% increase; P<.001) in each of the 5 states. Treatment of H pylori infection increased in each state and was significantly increased for the entire group of hospitalizations examined (8% increase overall; P = .001). Despite increased screening, detection of H pylori infection was less frequent than expected in every state, (13%-24%) and did not increase in any state. Screening for and counseling about NSAIDs did not significantly increase overall or in any state. In the Colorado cohort, the proportion of patients rehospitalized was unchanged in 1995 (8.9%) and 1997 (6.8%), and 124 patients (16%) in the combined 1995 and 1997 cohorts died within 1 year. Treatment for H pylori was not associated with a reduction in rehospitalization within 1 year (adjusted odds ratio [OR], 1.24; 95% confidence interval [CI], 0.65-2.36) or with a reduction in mortality (adjusted OR, 1.08; 95% CI, 0.68-1.71). Counseling about NSAID use was associated with a decrease in risk of 1-year rehospitalization for PUD (adjusted OR, 0.47; 95% CI, 0.22-0.99) and risk of all-cause mortality (adjusted OR, 0.44; 95% CI, 0.26-0.75).
Conclusions This quality improvement program for elderly patients with PUD resulted in increased screening for H pylori and increased treatment of H pylori infection but no change in counseling about NSAID use. However, with the low prevalence of H pylori detected, treatment of H pylori infection was not associated with a reduction in repeat hospitalization for PUD or subsequent mortality, whereas counseling about the risks of using NSAIDs was associated with a reduction in the risk of both outcomes.
Author Affiliations: Colorado Foundation for Medical Care, Aurora (Drs Brock, Sauaia, and Schluter and Ms Stevens); Department of Preventive Medicine, University of Colorado School of Medicine, Denver (Drs Brock, Sauaia, Ahnen, Marine, and Schluter); Department of Gastroenterology, Denver Veteran's Administration Hospital, Denver, Colo (Dr Ahnen); Qualidigm, Middletown, Conn (Dr Scinto); University of Connecticut Health Center School of Medicine, Farmington (Dr Scinto); Georgia Medical Care Foundation, Atlanta (Dr Karp); and Oklahoma Foundation for Medical Quality, Oklahoma City (Dr Bratzler).
RELATED ARTICLES
Improving Care for Elderly Patients With Peptic Ulcer Disease: Should the Focus Be on Drugs or Bugs?
Javed Butler, Reid Ness, and Theodore Speroff
JAMA. 2001;286(16):2023-2024.
EXTRACT
| FULL TEXT
October 24/31, 2001
JAMA. 2001;286(16):2033-2034.
EXTRACT
| FULL TEXT
Peptic Ulcers
JAMA. 2001;286(16):2052.
PDF
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Are Low-Income Elderly Patients at Risk for Poor Diabetes Care?
McCall et al.
Diabetes Care 2004;27:1060-1065.
ABSTRACT
| FULL TEXT
Improving Care for Elderly Patients With Peptic Ulcer Disease: Should the Focus Be on Drugs or Bugs?
Butler et al.
JAMA 2001;286:2023-2024.
FULL TEXT
|
