Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease: Results From a Quality Improvement Project
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 patie...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2001-10, Vol.286 (16), p.1985-1993 |
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| container_title | JAMA : the journal of the American Medical Association |
| container_volume | 286 |
| creator | Brock, Jane Sauaia, Angela Ahnen, Dennis Marine, William Schluter, William Stevens, Beth R Scinto, Jeanne D Karp, Herbert Bratzler, Dale |
| description | 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 |
| doi_str_mv | 10.1001/jama.286.16.1985 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_journals_211360178</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>194313</ama_id><sourcerecordid>87431742</sourcerecordid><originalsourceid>FETCH-LOGICAL-a252t-c06a779b1f9524ffede9b8f06e43727d3704dd37b70a78db9400872c7538e6593</originalsourceid><addsrcrecordid>eNpFkNFLwzAQxoMobk7f9UUO3zuTpm0S32RubjDYFIePJW2v2NKuM0mF-ewfbmATj-Pu4X733fERcs3omFHK7mvd6nEokzHzqWR8QoYs5jLgsZKnZEipkoGIZDQgF9bW1Afj4pwMGEsSoXg8JD9r0-VoLXQlTLRB0NsCVr3LuxYtlJ2BaVOgafaw1q7CrbMw7-yucrqpvrGA98p9wBp3rsph0-Ro4KmyqC0-wCvavvH8zHQtaHjp_Yrbw6Ldme4LW68F_niNubskZ6VuLF4d-4hsZtO3yTxYrp4Xk8dloMM4dEFOEy2Eylip4jAqSyxQZbKkCUZchKLggkaFr5mgWsgiUxGlUoS58JZgEis-IncHXf_BZ4_WpXXXm60_mYaM8YQyIT10e4T6rMUi3Zmq1Waf_nnmgZsD4M3_n6qIM85_AXDFd2s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211360178</pqid></control><display><type>article</type><title>Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease: Results From a Quality Improvement Project</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Brock, Jane ; Sauaia, Angela ; Ahnen, Dennis ; Marine, William ; Schluter, William ; Stevens, Beth R ; Scinto, Jeanne D ; Karp, Herbert ; Bratzler, Dale</creator><creatorcontrib>Brock, Jane ; Sauaia, Angela ; Ahnen, Dennis ; Marine, William ; Schluter, William ; Stevens, Beth R ; Scinto, Jeanne D ; Karp, Herbert ; Bratzler, Dale</creatorcontrib><description>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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.286.16.1985</identifier><identifier>PMID: 11667935</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Anti-Inflammatory Agents, Non-Steroidal - adverse effects ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Clinical outcomes ; Disease ; Female ; Guideline Adherence ; Helicobacter Infections - diagnosis ; Helicobacter Infections - drug therapy ; Helicobacter pylori ; Hospital Mortality ; Hospitals - standards ; Hospitals - statistics & numerical data ; Humans ; Infections ; Logistic Models ; Male ; Medical screening ; Medicare - standards ; Middle Aged ; Older people ; Outcome and Process Assessment (Health Care) ; Patient Readmission ; Peptic Ulcer - etiology ; Peptic Ulcer - therapy ; Practice Guidelines as Topic ; Quality control ; Quality Indicators, Health Care ; Ulcers ; United States - epidemiology</subject><ispartof>JAMA : the journal of the American Medical Association, 2001-10, Vol.286 (16), p.1985-1993</ispartof><rights>Copyright American Medical Association Oct 24/Oct 31, 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.286.16.1985$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.286.16.1985$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,780,784,3340,27924,27925,76489,76492</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11667935$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brock, Jane</creatorcontrib><creatorcontrib>Sauaia, Angela</creatorcontrib><creatorcontrib>Ahnen, Dennis</creatorcontrib><creatorcontrib>Marine, William</creatorcontrib><creatorcontrib>Schluter, William</creatorcontrib><creatorcontrib>Stevens, Beth R</creatorcontrib><creatorcontrib>Scinto, Jeanne D</creatorcontrib><creatorcontrib>Karp, Herbert</creatorcontrib><creatorcontrib>Bratzler, Dale</creatorcontrib><title>Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease: Results From a Quality Improvement Project</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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.</description><subject>Aged</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Clinical outcomes</subject><subject>Disease</subject><subject>Female</subject><subject>Guideline Adherence</subject><subject>Helicobacter Infections - diagnosis</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter pylori</subject><subject>Hospital Mortality</subject><subject>Hospitals - standards</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Infections</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical screening</subject><subject>Medicare - standards</subject><subject>Middle Aged</subject><subject>Older people</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Patient Readmission</subject><subject>Peptic Ulcer - etiology</subject><subject>Peptic Ulcer - therapy</subject><subject>Practice Guidelines as Topic</subject><subject>Quality control</subject><subject>Quality Indicators, Health Care</subject><subject>Ulcers</subject><subject>United States - epidemiology</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkNFLwzAQxoMobk7f9UUO3zuTpm0S32RubjDYFIePJW2v2NKuM0mF-ewfbmATj-Pu4X733fERcs3omFHK7mvd6nEokzHzqWR8QoYs5jLgsZKnZEipkoGIZDQgF9bW1Afj4pwMGEsSoXg8JD9r0-VoLXQlTLRB0NsCVr3LuxYtlJ2BaVOgafaw1q7CrbMw7-yucrqpvrGA98p9wBp3rsph0-Ro4KmyqC0-wCvavvH8zHQtaHjp_Yrbw6Ldme4LW68F_niNubskZ6VuLF4d-4hsZtO3yTxYrp4Xk8dloMM4dEFOEy2Eylip4jAqSyxQZbKkCUZchKLggkaFr5mgWsgiUxGlUoS58JZgEis-IncHXf_BZ4_WpXXXm60_mYaM8YQyIT10e4T6rMUi3Zmq1Waf_nnmgZsD4M3_n6qIM85_AXDFd2s</recordid><startdate>20011024</startdate><enddate>20011024</enddate><creator>Brock, Jane</creator><creator>Sauaia, Angela</creator><creator>Ahnen, Dennis</creator><creator>Marine, William</creator><creator>Schluter, William</creator><creator>Stevens, Beth R</creator><creator>Scinto, Jeanne D</creator><creator>Karp, Herbert</creator><creator>Bratzler, Dale</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope></search><sort><creationdate>20011024</creationdate><title>Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease: Results From a Quality Improvement Project</title><author>Brock, Jane ; 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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.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>11667935</pmid><doi>10.1001/jama.286.16.1985</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2001-10, Vol.286 (16), p.1985-1993 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_journals_211360178 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Clinical outcomes Disease Female Guideline Adherence Helicobacter Infections - diagnosis Helicobacter Infections - drug therapy Helicobacter pylori Hospital Mortality Hospitals - standards Hospitals - statistics & numerical data Humans Infections Logistic Models Male Medical screening Medicare - standards Middle Aged Older people Outcome and Process Assessment (Health Care) Patient Readmission Peptic Ulcer - etiology Peptic Ulcer - therapy Practice Guidelines as Topic Quality control Quality Indicators, Health Care Ulcers United States - epidemiology |
| title | Process of Care and Outcomes for Elderly Patients Hospitalized With Peptic Ulcer Disease: Results From a Quality Improvement Project |
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