The quality of care for medicare patients with peptic ulcer disease

OBJECTIVE: The aim of this study was to examine quality of care for hospita lized Medicare beneficiaries with peptic ulcer disease. METHODS: Collaborating with five Peer Review Organizations, we used 1995 Me dicare claim files to select samples of inpatients with a principal diagnos is of peptic ulcer disease. Quality of care indicators developed by content experts included percentages for ulcer patients tested for Helicobacter py lori (H. pylori); biopsied patients who received tissue tests; H. pylori-po sitive patients who received appropriate therapy; and ulcer patients screen ed for preadmission nonsteroidal anti-inflammatory drug (NSAID) use and cou nseled about risks. RESULTS: Of 2,644 patients eligible for medical record review, 56% were tes ted for H. pylori, and 73% of those testing positive were treated appropria tely, 84% of patients with endoscopic biopsies received a tissue test for H . pylori; 74% of patients were screened for preadmission NSAID use. 24% had documented counseling of NSAID use, and only 2% had documented counseling on the ulcer risk of NSAID use. Statistically significant regional variatio n occurred in four of six quality indicators. Outpatient records were revie wed for 529 patients to document prior outpatient H. pylori in this populat ion; only 2% (n = 12) were tested for H. pylori in the year before admissio n. CONCLUSIONS: Opportunities exist to improve quality of care by testing for and treating H. pylori in hospitalized Medicare beneficiaries with peptic u lcer disease and to improve screening for NSAIDs and counseling on ulcer ri sks.