Co-Management Between Hospitalist and Hepatologist Improves the Quality of Care of Inpatients With Chronic Liver Disease

Abstract

These results support co-management between hospitalists and hepatologists as a superior model of care for hospitalized patients with SBP. Furthermore, this study adds to the growing literature indicating that efforts are needed to improve the quality of care delivered to CLD patients.

Novel educational interventions in residency increase knowledge of chronic liver disease and career interest in hepatology

“…The rotation in this study is the first described to place IM residents in the role of a specialist comanager, which decreases the burden of tasks present in the primary manager role, as in the liver rotation described by Lai et al, (28) but also requires the physician to assume more active responsibility for a patient's care plan compared to a consultant. (29) Comanagement has been shown to improve the quality of care for CLD patients and is increasingly recognized as a necessary model in the outpatient management of CLD, (23,30) but its educational value for residents has never before been assessed. Interestingly, the most frequently cited negative aspects of the rotation-lack of complete ownership of patients and redundancy of two rounds-both seem to stem from the comanagement model.…”

“…This study was conducted during the academic year of 2014‐2015 at the University of Chicago Medical Center, a large, urban academic hospital with a liver transplant program performing an average of 26 liver transplants per year. At the University of Chicago, CLD and pretransplant inpatients requiring management of decompensated liver disease and posttransplant patients with nonsurgical complications are admitted to a unit comanaged by a team of academic hospitalists and hepatologists (comprised of a hepatology attending, a gastroenterology fellow, and a transplant hepatology fellow) . In this model, each patient's care plan is established at daily multidisciplinary rounds, which includes the hospitalist and hepatology teams as well as representatives from the transplant surgery team, transplant nurses, a transplant social worker, a transplant pharmacist, a transplant nutritionist, and the liver unit's floor nursing staff.…”

Closing the Quality Chasm in Cirrhosis

“…However, access to specialists can be a significant barrier because there are only a few hundred board‐certified transplant hepatologists and physicians who focus on liver disease in the United States. Viable alternatives to overcome this shortage include funneling patients to the specialist through outpatient Hepatology Clinical Service Lines and inpatient units with comanagement between hospitalists and hepatologists or hepatology‐run “Liver Units.” In addition, different modes of telemedicine‐based health delivery are appealing, yet the data supporting such avenues in patients with CLD beyond hepatitis C care are limited …”

Hospitalists on an Inpatient Tertiary Care Oncology Teaching Service

“…2 Moreover, a recent study showed that comanagement between hospitalists and hepatologists improved quality of care for hospitalized patients with chronic liver disease. 3 Because hospitalists practice in various settings with unique patient populations, knowledge and skills become specialized and tailored to inpatient needs. Hospitalist medicine at a comprehensive cancer center takes on special significance because of the complex medical needs of hospitalized oncology patients.…”