The description of outcomes in Medicare patients hospitalized with peptic ulcer disease

OBJECTIVE: The objective of this study was to describe outcomes of care for Medicare patients hospitalized with peptic ulcer disease from 1992 through 1997 and to identify factors related to cost, length of stay, and readmiss ion rates. METHODS: General descriptive statistics were obtained from Medicare inpatie nt claims data by year, endoscopy grouping, diagnosis related group code, a nd principal diagnosis code. From abstracted clinical data, associations we re derived for length of stay, readmission rates, and the following process es of care: screening or treatment for Helicobacter pylori; screening for n onsteroidal antiinflammatory drug (NSAID) use; and the performance of endos copy. The Acute Physiology and Chronic Health Evaluation method was used to estimate patient health status for the study. RESULTS: During the 6-yr study, there were 878,212 claims, which constitute d 1.3% of the total Medicare claims. The total Medicare payment far peptic ulcer claims was estimated at $4.8 billion. The inpatient mortality rare wa s 4.5%. Readmission rates remained relatively constant during the study per iod but decreased significantly when NSAID screening was documented during the hospitalization. Admission rates, length of stay, and mortality decline d progressively during the study period. A reduction in length of stay of a pproximately 1 day was observed when screening or treatment for H. pylori, screening for NSAID use, or the performance of endoscopy was documented. CONCLUSIONS: Peptic ulcer disease has an important impact on the Medicare p opulation with respect to cost, recurrence, and mortality. Adherence to sel ected processes of care is associated with shorter length of stay and lower readmission rates. (Am J Gastroenterol 2000;95:264-270. (C) 2000 by Am. Ce ll. of Gastroenterology).