The quality of care for Medicare patients with peptic ulcer disease.
OBJECTIVE
The aim of this study was to examine quality of care for hospitalized Medicare beneficiaries with peptic ulcer disease.


METHODS
Collaborating with five Peer Review Organizations, we used 1995 Medicare claim files to select samples of inpatients with a principal diagnosis of peptic ulcer disease. Quality of care indicators developed by content experts included percentages for ulcer patients tested for Helicobacter pylori (H. pylori); biopsied patients who received tissue tests; H. pylori-positive patients who received appropriate therapy; and ulcer patients screened for preadmission nonsteroidal anti-inflammatory drug (NSAID) use and counseled about risks.


RESULTS
Of 2,644 patients eligible for medical record review, 56% were tested for H. pylori, and 73% of those testing positive were treated appropriately; 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 variation occurred in four of six quality indicators. Outpatient records were reviewed for 529 patients to document prior outpatient H. pylori in this population; only 2% (n = 12) were tested for H. pylori in the year before admission.


CONCLUSIONS
Opportunities exist to improve quality of care by testing for and treating H. pylori in hospitalized Medicare beneficiaries with peptic ulcer disease and to improve screening for NSAIDs and counseling on ulcer risks.
Ofman
J J
JJ
Cedars-Sinai Department of Medicine and Health Services Research, Los Angeles, California, USA.
Etchason
J
J
Alexander
W
W
Stevens
B R
BR
Herrin
J
J
Cangialose
C
C
Ballard
D J
DJ
Bratzler
D
D
Elward
K S
KS
FitzGerald
D
D
Culpepper-Morgan
J
J
Marshall
B
B
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis; D016480:Helicobacter pylori; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D010437:Peptic Ulcer / Q000139:chemically induced / Q000382:microbiology / Q000628:therapy*; D011787:Quality of Health Care; D014481:United States
D000894:Anti-Inflammatory Agents, Non-Steroidal