Is the volume-outcome relationship sustained in psychiatric care?
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.