Utilization of Health Care Resources for Low-Risk Patients with Acute, Nonvariceal Upper GI Hemorrhage

An Historical Cohort Study

Published in: Gastrointestinal Endoscopy, v. 55, no. 3, Mar. 2002, p. 321-327

Posted on RAND.org on January 01, 2002

by Gareth S. Dulai, Ian M. Gralnek, Tommy T. Oei, Dong Chang, Gwen Alofaituli, Jeffrey Gornbein, Katherine L. Kahn

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BACKGROUND: Adults hospitalized with acute, nonvariceal upper GI hemorrhage can be accurately stratified according to their risk of subsequent adverse outcomes by using the Rockall score. Low-risk patients (Rockall score less-than-or-equal 2) may be candidates for early discharge. METHODS: Cases were identified with ICD-9-CM codes for calendar years 1997 and 1998. Medical record data to determine patient Rockall risk score, health care resource utilization, and adverse outcomes were abstracted with standardized forms. RESULTS: Fifty-three of 175 (30%) cases had Rockall scores < or =2. As predicted, those patients with Rockall scores < or =2 had a low risk of adverse outcomes with only 2 of 53 (4%) meeting criteria for recurrent bleeding as defined by the Rebleed variable, and no mortality. These low-risk patients had a mean hospital stay of 2.6 plus minus 2.1 days; 49% were admitted to an intermediate or intensive care unit bed and 57% were given H2 receptor antagonists intravenously. CONCLUSIONS: The proportion of patients admitted with acute, nonvariceal, upper GI hemorrhage with Rockall Scores < or =2 was substantial. Adverse outcomes were rare. In contrast, the level of health care resource utilization appeared high. The Rockall score has potential as a clinically based concurrent decision rule to improve the quality of care by finding those patients less likely to require intensive health care services.

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