title: Management of acute nonvariceal upper gastrointestinal hemorrhage: comparison of an American and a Canadian medical centre.
abstract: OBJECTIVE
  Acute nonvariceal upper gastrointestinal hemorrhage (UGIH) remains a common indication for hospital admission. Differences in the structure, process and outcomes of care in the management of acute nonvariceal UGIH between providers in Canada and the United States have not been previously characterized. The aim of the present study was to compare the structure, process and outcomes of care between a Canadian and an American tertiary care medical centre in the management of acute nonvariceal UGIH.
  
  
  METHODS
  Data were collected from identified cases of acute non-variceal UGIH at the two medical centres over two years. Process measures analyzed included the level of care (intensive care unit [ICU] monitored bed versus unmonitored bed) and hospital length of stay (HLOS). Outcomes assessed included rebleeding, inhospital mortality and readmission and/or death within 30 days of admission.
  
  
  RESULTS
  One hundred seventy-five and 83 cases of acute non-variceal UGIH were identified at the American and Canadian centres, respectively. Cases at the American centre had a lower median HLOS, (2.6 versus 3.9 days, P<0.001) but were significantly more likely to be treated in an ICU or monitored setting (67% versus 16%, P<0.001). There were no significant differences in rates of rebleeding or death in hospital or within 30 days of discharge.
  
  
  CONCLUSIONS
  Marked differences exist in the process of care between the Canadian and American medical centres in the management of acute nonvariceal UGIH, despite similar patient severity. Outcomes between the two centres were similar. Minimizing disparity in the process of care of acute UGIH between the two centres may reduce excessive use of resources in the management of acute UGIH without promoting adverse outcomes.
authors.affiliation: Veterans Affairs Greater Los Angeles Health Care System, California, USA. lauraellyn@yahoo.com
authors.forename: Laura E
authors.initials: LE
authors.lastname: Targownik
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Gareth S
authors.initials: GS
authors.lastname: Dulai
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
authors.forename: Tommy
authors.initials: T
authors.lastname: Oei
authors.forename: Charles N
authors.initials: CN
authors.lastname: Bernstein
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D004932:Esophageal and Gastric Varices; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D014481:United States; D041742:Upper Gastrointestinal Tract