Screening for Helicobacter pylori and Nonsteroidal Anti-inflammatory Drug Use in Medicare Patients Hospitalized With Peptic Ulcer Disease

Background: Peptic ulcer disease has well-defined causes, with most cases related to Helicobacter pylori infection and nonsteroidal anti-inflammatory drug use. Objectives: To report performance rates on measures of care related to peptic ulcer disease in hospitalized Medicare patients and to identify improvement opportunities. Methods: Retrospective study of 2267 Medicare beneficiaries hospitalized with peptic ulcer disease. Data were obtained from 2 sources: medical records (n = 1580) from 80 hospitals—16 hospitals in each of 5 states (Alabama, Florida, Louisiana, Tennessee, and Texas)—and a national random sample (n = 687). Three measures of care were evaluated: (1) rate of diagnostic screening or treatment for H pylori infection, (2) rate of screening for nonsteroidal anti-inflammatory drug use on admission to the hospital, and (3) rate of assessment of risk factors for recurrence. Results: The rate of screening or treatment for H pylori infection was 52.9% to 59.8% among the 5 states and 55.6% in the national random sample. The rate of screening for nonsteroidal anti-inflammatory drug use was 64.6% to 75.4% among the states and 73.4% in the national random sample. The rate of assessment at discharge from the hospital for additional risks for ulcer recurrence was 66.1% to 73.6% among the states and 70.9% in the national random sample. Conclusions: Based on hospital records, slightly more than half of the Medicare patients admitted with diagnoses studied are being considered for H pylori eradication. If recurrence of this disease is to be reduced, physicians must adopt current screening and treatment recommendations. Arch Intern Med. 1999;159:149-154