ENDOSCOPIC PRACTICE FOR UPPER GASTROINTESTINAL HEMORRHAGE - DIFFERENCES BETWEEN MAJOR TEACHING AND COMMUNITY-BASED HOSPITALS

Background: Differences in endoscopic practice in major teaching and c ommunity hospitals are not known. Methods: A total of 1031 consecutive patients discharged from 13 hospitals (4 major teaching, 9 others) in 1994 with upper gastrointestinal hemorrhage were studied. Data obtain ed from chart abstraction included endoscopic findings and therapy and selected outcomes. Multivariable analyses adjusted for admission seve rity of illness and endoscopic findings. Results: Rates of endoscopy w ere similar between patients admitted to major teaching and other hosp itals, although procedures to control hemorrhage were used more often in major teaching hospitals (35% vs. 19%, p < 0.001). Use of endoscopi c therapy was higher in major teaching hospitals for lesions in which therapy is recommended, as well as other lesions. Recurrent bleeding w as also more common in major teaching hospitals (14.3% vs. 7.8%, p = 0 .001), and the difference persisted in multivariable analysis (odds ra tio 1.69: 95% CI [1.09 to 2.64], p = 0.02). Unadjusted and adjusted le ngth of stay were somewhat shorter in major teaching hospitals. Conclu sions: There was large variation in the use of endoscopic therapy, wit h higher rates observed in major teaching hospitals for lesions in whi ch therapy is recommended, as well as other stigmata. Further studies are needed to better define the reasons for the practice variation and to assess the impact on other outcomes such as readmission and costs.