The Role of Hospital Characteristics in Clinical and Quality Outcomes for Gastrointestinal Bleeding in a National Cohort.

Abstract

There is substantial variability in patient outcomes for gastrointestinal bleeding (GIB) across hospitals. This study aimed to identify hospital factors associated with GIB outcomes. This was a retrospective cohort study of Medicare fee-for-service beneficiaries hospitalized for GIB from 2016-2018. These data were merged with the American Hospital Association Annual Survey data to incorporate hospital characteristics. We used generalized linear mixed effects models to estimate the effect of hospital level characteristics on patient outcomes after adjusting for patient risk factors including anticoagulant and antiplatelet use, recent GIB, and comorbidities. The primary outcome was 30-day mortality and secondary outcomes included length of stay (LOS), and a composite outcome of 30-day readmission or mortality. Factors associated with improved GIB 30d mortality included large hospital size (defined as beds>400, OR: 0.93 (0.90, 0.97)), greater case volume (OR 0.97 (0.96, 0.98)) increased residents and nurse staffing (OR: 0.88 (0.83, 0.94)), and blood donor center designation (OR: 0.93 (0.88, 0.99)). Patients treated at a hospital with multiple advanced capabilities, such as availability of advanced endoscopy, advanced ICU capabilities (both a medical-surgical ICU and cardiac ICU), blood donor center, and liver transplant center, had a 22% reduction in 30-day mortality risk, compared to those hospitalized in a hospital with none of these services (OR: 0.78 (0.68, 0.91)). However, LOS increased with additional services. Patients hospitalized for GIB at hospitals with multiple advanced specialized capabilities have lower mortality but longer lengths of stay. Further research should examine the processes of care linked to these services that contribute to improved mortality in GIB.