A team from the USA investigated process of care and outcomes in elderly patients hospitalized with peptic ulcer disease (PUD).
Since publication in 1994 of guidelines for management of PUD, trends in physician practice and outcomes related to guideline application have not been evaluated.
A total of 4292 sequential patients, hospitalized at acute care hospitals with a principal diagnosis of PUD, were enrolled in the study. All were hospitalized in 5 U.S. states in 1995, and were followed-up in 1997.
Outcomes were evaluated for 752 patients in a single state (Colorado).
Changes in rates of screening for Helicobacter pylori infection and H. pylori treatment were monitored in the patients. In addition, screening for nonsteroidal anti-inflammatory drug (NSAID) use, and counseling about NSAID use was measured.
Outcomes included rehospitalization for PUD and all-cause mortality within 1 year of discharge in Colorado.
Screening for H. pylori infection increased significantly (12%-19% increase) in each of the 5 states.
|Counseling about NSAID use was associated with a decrease in rehospitalization and mortality.|
| Journal of the American Medical Association |
Treatment of H. pylori infection increased in each state and was significantly increased for the entire group of hospitalizations examined (8% increase overall).
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.
The researchers found that 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%).
Some 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) or with a reduction in mortality (OR = 1.08).
Counseling about NSAID use was associated with a decrease in risk of 1-year rehospitalization for PUD (OR = 0.47) and risk of all-cause mortality (OR = 0.44).
Dr Jane Brock, of the Colorado Foundation for Medical Care, Aurora and the University of Colorado School of Medicine, Denver, said on behalf of the group, "This quality improvement program for elderly patients with PUD resulted in increased screening for H. pylori and increased treatment of H. pylori infection. However, there was no change in counseling about NSAID use."
"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.
"On the other hand, counseling about the risks of using NSAIDs was associated with a reduction in the risk of both outcomes," she concluded.