Chicago—In patients with acute gastrointestinal bleeding, meeting quality-of-care indicators reduces length of stay in the hospital, a study has found.
The retrospective study, involving 700 patients, is consistent with a series of other initiatives suggesting that adhering to and documenting quality indicators improves outcomes in practice.
The quality indicators most associated with a reduced length of stay (LOS) were performance of orthostatics in patients with normal vitals, placement of large-bore IV lines and appropriate deployment or non-deployment of hemostasis, said Carl Nordstrom, MD, chief GI fellow in the University of California, Los Angeles’ integrated gastroenterology training program.
Of the 26 quality indicators that were considered, adherence to eight was evaluated, according to Dr. Nordstrom, who presented the findings at Digestive Disease Week 2014 (abstract 330). In addition to the four indicators most closely associated with LOS, these included appropriate documentation of nasogastric lavage findings, admission of hypovolemic patients to an ICU, endoscopy within 24 hours and use of a large-bore therapeutic endoscope.
The patients were treated over a 10-year period (1996-2007) at a single Veterans Affairs medical center. In general, the greater the number of quality indicators met, the shorter the hospital stay, the researchers found. This included a significant difference in the average stay between those in whom a single quality indicator was met and those without any documented quality indicators (6.5 vs. 10 days; P=0.003). Although the difference for those in whom four to six quality indicators were achieved was only marginally better than for those with one to three, the average stay for those in whom all eight quality indicators were met was only four days.
The researchers found no association between quality indicators and a patient’s risk for death, but incremental increases in the number of quality indicators performed were linked to a substantial reduction in the need for a second endoscopy in addition to the reduction in LOS.
“There is a large variation in the process of care among institutions for acute gastrointestinal bleeds,” Dr. Nordstrom said. He suggested that these data provide evidence that the quality indicators could reduce hospital stays, if not improve overall outcomes in gastrointestinal (GI) bleeds, but cautioned that these findings “should be confirmed in a prospective study.”
Using quality indicators to guide care is a growing phenomenon. In colonoscopy, for example, some third-party payors are considering documentation of quality indicators, such as an endoscope withdrawal time of at least six minutes, for reimbursement. In managing GI bleeds, however, Dr. Nordstrom said prospective evidence is needed to show that adhering to such indicators affects outcomes.
James Scheiman, MD, professor of gastroenterology at the University of Michigan, in Ann Arbor, said it is critical to demonstrate that establishing these kinds of processes of care actually changes physician behavior.
“Is it that quality indicators matter or do better doctors do better with quality indicators?” he asked. He expressed concern about “pop up” reminders in electronic medical record systems calling for physicians to perform quality measures not yet proven to affect outcome.
Improving processes of care must be aligned with incentives in an integrated health care system that both encourages and facilitates physicians to adhere, Dr. Scheiman said. Quality indicators are useful and have the potential to improve outcomes while reducing cost, he added, but their real value emerges “if we can get people who are not very good at this to do it better.”
via General Surgery News – Quality-of-Care Measures in Acute GI Bleeding Cuts Hospital Stay.