Impact of physician specialty on the cost of nonvariceal upper GI bleeding care.
OBJECTIVE
Upper GI bleeding (UGIB) is a common medical emergency that leads to a high consumption of medical resources and costs. We aimed to analyze the influence of physician specialty on the costs of nonvariceal UGIB care.


METHODS
We retrospectively assessed 350 nonvariceal UGIB episodes that were primarily cared for by gastroenterologists (n = 142), internists (n = 67), or surgeons (n = 141). Gastroenterologists followed evidence-based clinical protocols that included early endoscopy and early hospital discharge for uncomplicated bleeding. A risk score system was used to control for severity of illness. Linear regression analyses were performed to find out predictors of costs and the influence of specialist care on length of stay (LOS).


RESULTS
The overall mean hospital cost was significantly lower in patients cared for by gastroenterologists (EUR 1,630) than in those managed by internists (EUR 3,745, p < 0.001) or surgeons (EUR 2,513, p < 0.05). The mean LOS was the variable with highest influence on total cost. Patients cared for by gastroenterologists had a mean LOS significantly shorter (7.3 days) than that of those treated by internists (16.2 days, p < 0.001) or surgeons (11 days, p < 0.001). Hospital costs and LOS differences were maintained when adjusting for severity of illness. In caring for low risk patients, nongastroenterologists had a higher probability of having a hospital stay longer than 4 days (odds ratio = 18.4, Cl = 4.6-73.6, p < 0.001).


CONCLUSIONS
The implementation of specific evidence-based protocols by gastroenterologists reduces length of hospital stay and saves medical costs in patients with nonvariceal UGIB, especially those at low risk.
Pardo
Alberto
A
Gastroenterology Department, University Hospital of Canary Islands, Tenerife, Spain.
Durández
Rosa
R
Hernández
Manuel
M
Pizarro
Angeles
A
Hombrados
Manoli
M
Jiménez
Alejandro
A
Planas
Ramón
R
Quintero
Enrique
E
D000368:Aged; D016145:Endoscopy, Digestive System; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D013502:General Surgery / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies