Outpatient management of nonvariceal XXXX : unexpected mortality in Medicare beneficiaries.

@entity1 @entity1066 @entity360
BACKGROUND _ AIMS: Outpatient management of selected @entity1 with nonvariceal @entity360 ( @entity360 ) has been proposed as a mechanism to decrease resource utilization and expenditures. However, the true prevalence and outcomes of this practice have not been well evaluated in population-based studies. METHODS: We identified a cohort of 9123 episodes of @entity360 in 2004 Medicare claims data, including 3506 (38.4%) managed as outpatients. Clinical characteristics, treatment, and outcomes were compared between inpatient and outpatient groups. In order to adjust for potential selection bias in outpatient treatment, propensity score analysis was used to divide @entity1 into quartiles of likelihood for inpatient treatment. RESULTS: Inpatients tended to be older, with higher comorbidity scores, and were more likely to have a bleeding @entity1066 or tear. Inpatients were also more likely to undergo endoscopy, including early endoscopy and therapeutics, and require surgery. The overall 30-day mortality rate was 8.0% in the inpatient group and 6.3% in the outpatient group (P< .001), and in the quartile of @entity1 most likely to be managed as inpatients, the 30-day mortality rate was higher in outpatients than in inpatients. CONCLUSIONS: The prevalence of outpatient management of @entity360 in the Medicare population was almost 40%, and although @entity1 were likely selected for outpatient management based on clinical criteria, the overall mortality rate in outpatients was considerable. Any potential financial benefit should be balanced against significant mortality rates, at least some of which could possibly be avoided with hospitalization. More optimal selection of candidates for outpatient therapy is likely needed.
