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PubMed2005

Can electronic routine data act as a surrogate for patient-assessed outcome measures?

OBJECTIVES: There has been a rapid growth in the use of patient-assessed outcomes (PAOs) that are measured in the assessment of health technologies. The process of collection of such measures can be costly, and there may be problems associated with the ability of the patient to complete them. The use of electronically stored routine data may reduce costs and overcome the problems associated with patient completion. The feasibility of using routine data surrogates for the UK Inflammatory Bowel Disease Questionnaire (UKIBDQ) and the Short Form 36 (SF-36) was examined. METHODS: Clinical terms and codes for the UKIBDQ and SF-36 questions were identified, and data from electronic routine sources were sought on patients participating in a randomized controlled trial. The presence or absence of relevant symptoms was used to generate surrogate scores, which were compared with the original scores. RESULTS: Most questions in the UKIBDQ and SF-36 were codable but only one third of the terms were recorded routinely in electronic form. The surrogate total IBDQ score had reasonable reliability (Kuder-Richardson coefficient = 0.51), but this reliability could not be determined for the SF-36. Intraclass correlations between routine and designed data were poor to weak. CONCLUSIONS: Although electronic routine data sources had the capacity to develop surrogate measures for patient assessed outcomes, there was evidence of wide underutilization of coding systems leading to an underreporting of symptoms. This finding is consistent with previous literature where only poor correlations were illustrated between patient assessed outcomes and surrogate scoring of symptoms.

Data Collection↗

PubMed2003

Overview of large database analysis in renal transplantation.

The discipline of renal transplantation has been fortunate in having one of the largest and most complete databases of any field of medical inquiry. Many analyses have been performed utilizing these databases and a wide array of views regarding the role and limitations of these analyses exists. In this manuscript, we hope to present the merits and limitations of large database analysis in renal transplantation. In addition, we will attempt to go over the major databases' structures and the critical issues of coding, verification and clinical awareness that help maintain the integrity of this type of analysis. Other fundamental issues that will be covered include the relationship of single center and randomized prospective studies with database analyses, statistical considerations, and hidden selection bias inherent in registry analysis. We hope to present both a guide to investigators who are first embarking on large-scale database analysis and also to present a fair view of the utility and limitations of a potentially very useful research tool in renal transplantation.

Databases, Factual↗

PubMed1997

Comparisons of the abilities of a neural network and three consultant oral surgeons to make decisions about third molar removal.

AIM: To compare the performance of a computer based decision support system (a neural network) and consultant oral and maxillofacial surgeons in making decisions about the need to remove lower third molars. DESIGN AND SETTING: Receiver operating characteristic (ROC) analysis at a hospital department of oral and maxillofacial surgery. SUBJECTS AND METHODS: Three consultant oral and maxillofacial surgeons indicated on a six-point rating scale how certain they were that each of 50 documented lower third molars required removal. Similar data were obtained from the neural network following appropriate coding of the clinical information. These data were compared with gold standard treatment decisions for each tooth based on National Institutes of Health Concensus criteria using ROC analysis. MAIN OUTCOME MEASURES: The area beneath each operator ROC curve (varying between zero and one with greater areas indicating better performance). RESULTS: The network performed as well a two consultants (P = 0.12/0.18, NS) and significantly better than the third (z = 526, P < 0.01). CONCLUSIONS: This work suggests that this computer based neural network could play a useful role in supporting dental practitioners making third molar referral decisions.

Adult↗

PubMed2001

Multicenter evaluation of PCR methods for detecting CMV DNA in blood donors.

BACKGROUND: CMV DNA screening may be a useful adjunct to serologic tests in distinguishing potentially infectious blood donations from those that are "CMV-safe." However, there is currently no consensus on the optimal assay method for accurate detection of CMV DNA in donors. STUDY DESIGN AND METHODS: A blinded multicenter evaluation of seven CMV PCR assays was performed by five laboratories by using coded sets of analytical controls and donor blood samples. RESULTS: Five assays displayed sufficient sensitivity for donor screening, as judged by consistent detection of a minimum of 25 CMV genome equivalents (geq) in analytical controls constructed to contain from 1 to 100 CMV geq in background DNA from 250,000 cells, while the other two assays displayed inadequate sensitivity. Three sensitive assays, two based on nested PCR directed at the UL93 and UL32 regions of the CMV genome and another test (Monitor Assay, Roche), did not detect CMV DNA in samples from any of 20 pedigreed CMV-seronegative, Western blot-negative (S-/WB-) donors. Two other assays based on nested PCR occasionally detected CMV DNA in S-WB- samples, and one sensitive nested PCR assay directed at UL123 detected CMV DNA in a large proportion (85%) of S-WB- samples. CONCLUSION: Seven CMV PCR assays currently used for research and/or diagnostic applications displayed marked variations in sensitivity, specificity, and reproducibility when applied to coded analytical and clinical control samples containing cellular DNA from the equivalent of 250,000 WBCs. These results will be useful in the selection of assays with performance characteristics appropriate to donor screening objectives. They may also help explain discrepant findings from previous studies that used PCR to determine CMV DNA prevalence in seronegative and seropositive blood donors.

AIDS-Related Opportunistic Infections↗

PubMed2006

Health care in Europe for women with genital mutilation.

The increasing number of immigrants from African countries practicing female genital mutilation (FGM) has raised concern in Europe. Health care professionals have developed three main responses: (1) technical guidelines for clinical management; (2) codes of conduct on quality of care; and (3) specialised health services for medical and psychological care and counselling. Much remains to be done, however, to ensure adequate care in Europe: (1) medico-legal/ethical discussions; (2) development of protocols to assist in making informed decisions; and (3) development of guidelines on counselling, communication strategies, and referral procedures. All agencies working in the field of FGM should be interlinked at the national level, in which members of the affected communities should be included. At the European level, a coordinated approach between all agencies should be developed.

Africa↗

PubMed1995

Sudden cardiac death in hypertrophic cardiomyopathy. Variability in phenotypic expression of beta-myosin heavy chain mutations.

BACKGROUND: Recent identification of mutations in the beta-myosin heavy chain gene (MYH7), a major responsible gene for HCM, has provided the opportunity to characterize genotype-phenotype correlation in HCM families. In this study we analysed the phenotypic expression of two beta-myosin heavy chain (beta MHC) mutations in three unrelated HCM families. METHODS: Living individuals from three unrelated HCM families (Families 1, 2, and 3) were screened by history, physical examination, electrocardiography, and two-dimensional echocardiography. Blood was collected from all individuals for DNA extraction. Polymerase chain reaction (PCR), restriction endonuclease digestion and chemical cleavage were utilized for detection of mutations. All mutations were confirmed by sequence analysis. RESULTS: Identification of mutations: A missense mutation in exon 13 of the beta MHC gene (Arg403 Gln) was detected in HCM patients from Families 1 and 2. PCR amplification of the exon 13 DNA, followed by Ddel digestion of the PCR product and gel electrophoresis, showed two fragments of 84 and 70 bp in normal individuals and four fragments of 84, 70, 52 and 32 bp in HCM patients. Sequence analysis showed substitution of an adenine for guanine at coding position 1208. In Family 3, a missense mutation in exon 16 of the beta MHC gene (Val606 Met) was detected in HCM patients. Chemical cleavage of the PCR products showed an uncleaved product of 337 bp in the normal individuals, while in the affected individuals, in addition to the uncleaved product, a 90 bp cleaved product was also detected, indicating the presence of a mismatch in one allele. Sequence analysis showed substitution of an adenine for guanine in coding position 1817. CLINICAL CHARACTERISTICS: Seven members of Family 1 had HCM, of whom five are alive. One patient died from sudden cardiac death (SCD) and another from recurrent cerebral emboli. In Family 2, 15 individuals had HCM of whom nine have died, seven from SCD. The mean age at the time of SCD was 33 years. The third family is comprised of 11 affected individuals and one obligate carrier, of whom one patient died at age 17 from progressive heart failure. Two additional individuals in this family have also succumbed to SCD to age 60. A variety of clinical and echocardiographic manifestations of HCM were present in each family. Logrank test of Kaplan-Meier survival curves indicates that Arg403 Gln mutation was associated with a poor prognosis in HCM families as compared to Val606 Met (P = 0.034). CONCLUSIONS: beta MHC mutations despite showing variable clinical and echocardiographic manifestations of HCM are predictors of survival in HCM families.

Adolescent↗

PubMed2001

The morphologic spectrum of hibernoma: a clinicopathologic study of 170 cases.

Hibernoma, an uncommon tumor of brown fat, has been described only in a few case reports and small series. The authors reviewed 170 cases of hibernoma and evaluated the morphologic features and the behavior of this tumor. The records from the Soft Tissue Registry of the Armed Forces Institute of Pathology from 1970 were searched for cases coded as "hibernoma." Clinical information and available slides from 170 hibernomas were reviewed. Immunohistochemical staining for S-100 and CD34 was performed on select cases. Follow-up information was obtained from the patients' medical records, the patients' physicians, and the patients themselves. Of 170 patients with hibernoma, 99 were men and 71 were women. The tumor occurred most commonly in adults, with a mean age of 38.0 years (age range, 2-75 years). Nine tumors occurred in pediatric patients. The most common anatomic locations included the thigh (n = 50), shoulder (n = 20), back (n = 17), neck (n = 16), chest (n = 11), arm (n = 11), and abdominal cavity/retroperitoneum (n = 10). The average duration of the tumor was 30.6 months. Tumor size ranged from 1 to 24 cm with an average dimension of 9.3 cm. All tumors were composed partly or principally of coarsely multivacuolated fat cells with small, central nuclei and no atypia. Four morphologic variants of hibernoma were identified: typical, myxoid, spindle cell, and lipoma-like. "Typical" hibernoma (n = 140) included eosinophilic cell, pale cell, and mixed cell types based on the tinctorial quality of the hibernoma cells. The myxoid variant (n = 14) contained a loose basophilic matrix. Spindle cell hibernoma (n = 4) had features of spindle cell lipoma and hibernoma; all occurred in the neck or scalp. The lipoma-like variant (n = 12) contained only scattered hibernoma cells. Immunohistochemically, 17 of 20 cases (85%) were positive for S-100 protein. Only one hibernoma of 20, a spindle cell variant, was positive for CD34, whereas other hibernoma variants were negative. Follow-up was obtained for 66 cases (39%) over a mean period of 7.7 years (range, 6 months-28 years). None of the patients with follow-up had a recurrence or metastasis, including eight with intramuscular tumors. No patient died of disease. Hibernoma is a tumor found most often in adults and most commonly in the thigh, with several morphologic variants. It is a benign tumor that does not recur with complete excision. Hibernomas should not be confused with atypical lipomas or well-differentiated liposarcoma.

Adolescent↗

PubMedDate not supplied

Causes of death following 1 year postinjury among individuals with traumatic brain injury.

OBJECTIVE: To investigate causes of death in individuals with traumatic brain injury (TBI). DESIGN: Retrospective cohort study. SETTING: Utilized data from the TBI Model Systems National Database, the Social Security Death Index, death certificates, and the US population age-race-gender-cause-specific mortality rates for 1994. PATIENTS: Two thousand one hundred forty individuals with TBI completing inpatient rehabilitation in 1 of 15 National Institute on Disability and Rehabilitation Research-funded TBI Model Systems of Care between 1988 and 2001, and surviving past 1 year postinjury. MAIN OUTCOME MEASURES: Primary cause of death based on the International Classification of Diseases--9th Revision--Clinical Modification-coded death certificates. RESULTS: Individuals with TBI were about 37 times more likely to die of seizures, 12 times more likely to die of septicemia, 4 times more likely to die of pneumonia, and about 3 times more likely to die of other respiratory conditions (excluding pneumonia), digestive conditions, and all external causes of injury/poisoning than were individuals in the general population of similar age, gender, and race. CONCLUSION: Long-term follow-up of individuals with TBI should increase vigilance for, and prevention of, diagnoses frequently causing death (circulatory disorders) and diagnoses with a high relative risk of causing death in this population (seizures, septicemia, respiratory and digestive conditions, and external causes of injury).

Adult↗

PubMedDate not supplied

The net cost of Alzheimer disease and related dementia: a population-based study of Georgia Medicaid recipients.

The objective of this study was to estimate the direct medical cost of Alzheimer disease (AD) and related dementia to the Georgia Medicaid program. A retrospective, cross-sectional, matched control group design was used. AD cases 50 years of age and older were identified by using International Classification of Diseases (9th edition, Clinical Modification) diagnosis codes from 1994 Georgia Medicaid administrative claims files. For every case, three age- and gender-matched non-AD controls were selected. Differences in average recipient Medicaid expenditures between cases and controls were estimated using weighted least squares regression analysis, adjusting for age, gender, race, Charlson comorbidity index, Medicare eligibility, and months of Medicaid eligibility. A total of 8,671 AD cases were identified (prevalence, 4.4%). The average adjusted annual Medicaid expenditure per AD recipient was $14,492 (U.S.). The net (i.e., excess) average annual Medicaid cost per AD recipient (i.e., the difference in adjusted mean expenditures between cases and controls) was estimated to be approximately $8,200. Excessive nursing home expenditures accounted for most of the additional cost of treating dementia (> 85%), although inpatient hospital, physician, outpatient, and prescription drug expenditures also were higher among patients with AD. Based on these estimates, Georgia Medicaid is projected to spend almost $70 million annually for AD and related dementia. The excessive cost attributable to AD poses a significant burden to the Georgia Medicaid program.

Aged↗

PubMed1997

Profiling the health service needs of populations using diagnosis-based classification systems.

Managed care presents the challenge to deliver health care services to populations from a fixed pool of dollars and be accountable for doing so. From a health plan and a community perspective, it is critical to have classification systems that adequately describe the health service needs of the population. This article describes the design and structure of the National Association of Children's Hospitals and Related Institutions Classification of Congenital and Chronic Health Conditions and illustrates its management applications from its first testing on a full-service, paid claims database. Capabilities and limitations of diagnosis-based classification systems and the International Classification of Diseases, Ninth Edition, Clinical Modification diagnosis codes that underpin such systems are discussed.

Ambulatory Care↗

PubMed2001

Gallstone pancreatitis: a community teaching hospital experience.

GOALS: The current study reviews the Bridgeport Hospital experience with gallstone pancreatitis (GP) and examines its incidence by race and gender. STUDY: Consecutive patients admitted with acute pancreatitis between October 1994 and October 1996 were identified using discharge diagnosis codes. Demographics and clinical information were abstracted. Patients were categorized as having definite GP, probable GP, and non-GP using the available information. RESULTS: One hundred twenty-three patients met criteria for acute pancreatitis. Of these, 40 met the criteria for definite GP; 14, probable; and 69, non-GP. The estimated incidence for acute pancreatitis was 45 per 100,000 person-years (95% CI = 41-58 per 100,000 person-years) for definite GP and was 20 per 100,000 person-years (95% CI = 14-25 per 100,000 person-years) for probably GP. Patients with definite or probable GP were predominantly white or Hispanic women and tended to be older. Only 16% of pancreatitis in black patients was associated with gallstones. Elevated alanine aminotransferase (ALT > 120 U/L) was highly specific (97%) in predicting GP, with a positive likelihood ratio of 18.3. Abdominal ultrasound was the most widely used imaging study. Complication rates were low. There was only one intrahospital death. CONCLUSIONS: The incidence of acute pancreatitis requiring hospitalization at our community hospital in 1994-1996 was 45 (95% CI = 41-58) per 100,000 person-years. Forty percent of these cases were associated with gallstones. Gallstone pancreatitis was more common among the elderly women and the white (white, non-Hispanic) population. Elevated ALT was highly specific in the prediction of GP.

Acute Disease↗

PubMed1998

Differences in mortality between elderly and younger adult trauma patients: geriatric status increases risk of delayed death.

BACKGROUND: Elderly patients suffer higher mortality rates after trauma than younger patients. This increased mortality is attributable to age, preexisting disease, and complications as well as injury severity. METHODS: Records from 5,139 adult patients from a Level I trauma center were retrospectively reviewed. Injury Severity Score (ISS), Revised Trauma Score (RTS), early mortality (<24 hours), and late mortality (>24 hours) were determined for elderly (> or =65 years) and younger (16-64 years) patients. Preexisting diseases and complications were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis coding. RESULTS: Mortality in elderly patients was twice that in younger patients despite equivalent injury severity (p < 0.001), and elderly patients were more likely to suffer later death than younger patients (p < 0.005). The prevalence of preexisting disease was greater in the elderly, as was the incidence of complications. Using logistic regression, ISS, RTS, preexisting cardiovascular or liver disease, the development of cardiac, renal, or infectious complications, and geriatric status were all independently predictive of late mortality (p < 0.05). CONCLUSION: Elderly trauma patients more frequently suffer late mortality than younger patients because of the combination of injury and increased preexisting disease and complications after injury. Aggressive treatment of the elderly trauma patient is warranted; however, in the face of significant preexisting disease or complications, survival is less likely. Predictive models of survival can be developed, taking into account preexisting disease and complications as well as admission parameters such as age, ISS, and RTS, and specific risk of mortality quantitated.

Adolescent↗

PubMed1997

The risk of hospitalization for congestive heart failure among older adults.

OBJECTIVES: The purpose of the study was to estimate the 8-year rate of hospitalization for congestive heart failure (CHF), to report the resources consumed, and to evaluate previously reported risk factors in a nationally representative sample of 7,286 older white and black adults. METHODS: Secondary analysis of baseline interview data was linked to Medicare hospitalization and death records for 1984 to 1991. Hospitalization for CHF was defined as having one or more episodes with an International Classification of Diseases (ninth revision, clinical modification) discharge code of 428. Combined and separate analyses of first-listed and second-through fifth-listed CHF discharge diagnoses were conducted. Multivariable proportional hazards models were used to evaluate the risks in pooled analyses of all white and black men and women and in separate stratified analyses of white men and white women. RESULTS: Over the 8-year period, 1,102 or 15.1% of the 7,286 older white and black adults were hospitalized for CHF (7.1% with first-listed and 8.1% with second- through fifth-listed diagnoses). The 1- and 5-year combined postdischarge mortality rates were 34.7% and 69.0%, respectively. In descending order, the major risk factors for being hospitalized for CHF in the combined, pooled analysis were age, being a white man, having lower body functional limitations, and having self-reported medical histories of coronary heart disease, heart attack, diabetes, and angina. The increased risk associated with age was not linear, and it diminished significantly over the course of life. Some significant differences were observed in the risk factors for hospitalization for first-listed versus second- through fifth-listed CHF and in the risk factors for white women versus white men. CONCLUSIONS: Hospitalization for CHF among older adults is a common, costly event with a poor prognosis. The differential risk for white men remains unexplained and warrants further study.

Black or African American↗

PubMed2002

Acute, unintentional pediatric brodifacoum ingestions.

BACKGROUND: Brodifacoum is the major rodenticide used in the United States today. It is similar to warfarin but has more potent and prolonged effects. Large overdoses and chronic intoxication have been associated with significant coagulopathies and death. Currently, the management of acute unintentional ingestions by young children is controversial. METHODS: American Association of Poison Control Centers (AAPCC) data from 1993 to 1996 were retrospectively searched for acute, unintentional brodifacoum exposures without coingestions followed-up to a known outcome in children aged 6 years and younger. The cases were analyzed by management site, symptoms, therapy, and outcome. Cases coded as having clinical or laboratory evidence of coagulopathy were further evaluated for severity. RESULTS: Our study reviewed 10,762 cases that involved single, acute, unintentional ingestions of brodifacoum. All of the patients were followed-up to a known outcome as defined by AAPCC data collection standards. In this cohort, there were no deaths or major effects reported. Although 67 patients reported evidence of coagulopathy, no major effects or deaths were reported. Minor and moderate effects were reported in 38 and 54 children, respectively. Management occurred outside of a healthcare facility in 5404 (50.2 %) cases. Approximately half of all the children received some form of gastrointestinal decontamination. Decontamination had no effect on the distribution of outcomes. Adverse effects from decontamination therapy were reported in 42 patients. CONCLUSION: Acute pediatric ingestions of brodifacoum rarely caused clinical effects and were not associated with life-threatening symptoms or death in young children. It seems reasonable that acute unintentional ingestions of small quantities of brodifacoum by young children can be adequately managed with home observation and parent education.

4-Hydroxycoumarins↗

PubMed2004

Mechanisms of tinnitus generation.

PURPOSE OF REVIEW: The current understanding of mechanisms of tinnitus generation is continuing to advance. This review is intended to outline new knowledge in the areas of neuroanatomy, physiology, psychophysics, and brain imaging that are revealing novel mechanisms of tinnitus development. Advances in these areas will open new avenues for effective treatment of tinnitus. RECENT FINDINGS: Application of high-pulse train electrical stimulation to the cochlea may be effective in restoring the normal pattern of spontaneous activity from the periphery that is interpreted by the auditory brainstem as coding for silence. Clinical and laboratory evidence for a significant interaction between the somatosensory and auditory systems has important implications for understanding and treating tinnitus. Application of principles of neuroplasticity and novel imaging techniques has expanded our understanding of tinnitus through analogous approaches to phantom limb pain. Finally, a novel receptor type recently located in auditory neurovascular structures has opened a new field of study of inflammatory mechanisms contributing to tinnitus. SUMMARY: Our understanding of the mechanisms that lead to a phantom auditory perception, and the associated debilitating consequences of this sensory experience, is continuing to improve. Tinnitus appears to be significantly affected in complex ways by somatosensory, limbic, and motor influences. Effective treatments will certainly emerge from these new areas of research.

Acoustic Stimulation↗

PubMed2006

How do providers assess antihypertensive medication adherence in medical encounters?

BACKGROUND: Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. Providers' communication with patients about their medication-taking behavior may be central to improving adherence. OBJECTIVE: The goal of this study was to characterize the ways in which providers ask patients about medication taking. DESIGN: Clinical encounters between primary care providers and hypertensive patients were audiotaped at 3 Department of Veterans' Affairs medical centers. PARTICIPANTS: Primary care providers (n=9) and African-American and Caucasian patients (n=38) who were diagnosed with hypertension (HTN). APPROACH: Transcribed audiotapes of clinical encounters were coded by 2 investigators using qualitative analysis based on sociolinguistic techniques to identify ways of asking about medication taking. Electronic medical records were reviewed after the visit to determine the BP measurement for the day of the taped encounter. RESULTS: Four different aspects of asking about medication were identified: structure, temporality, style and content. Open-ended questions generated the most discussion, while closed-ended declarative statements led to the least discussion. Collaborative style and use of lay language were also seen to facilitate discussions. In 39% of encounters, providers did not ask about medication taking. Among patients with uncontrolled HTN, providers did not ask about medications 33% of the time. CONCLUSION: Providers often do not ask about medication-taking behavior, and may not use the most effective communication strategies when they do. Focusing on the ways in which providers ask about patients' adherence to medications may improve BP control.

Antihypertensive Agents↗

PubMed2005

A chart-based method for identification of delirium: validation compared with interviewer ratings using the confusion assessment method.

OBJECTIVES: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). DESIGN: Prospective validation study. SETTING: Teaching hospital. PARTICIPANTS: Nine hundred nineteen older hospitalized patients. MEASUREMENTS: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. RESULTS: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. CONCLUSION: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes.

Aged↗

PubMed2000

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 readmission rates. METHODS: General descriptive statistics were obtained from Medicare inpatient claims data by year, endoscopy grouping, diagnosis related group code, and principal diagnosis code. From abstracted clinical data, associations were derived for length of stay, readmission rates, and the following processes of care: screening or treatment for Helicobacter pylori; screening for nonsteroidal antiinflammatory drug (NSAID) use; and the performance of endoscopy. 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 constituted 1.3% of the total Medicare claims. The total Medicare payment for peptic ulcer claims was estimated at $4.8 billion. The inpatient mortality rate was 4.5%. Readmission rates remained relatively constant during the study period but decreased significantly when NSAID screening was documented during the hospitalization. Admission rates, length of stay, and mortality declined progressively during the study period. A reduction in length of stay of approximately 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 population with respect to cost, recurrence, and mortality. Adherence to selected processes of care is associated with shorter length of stay and lower readmission rates.

Aged↗