Measurement of the quality of care of patients admitted with decompensated cirrhosis

Ghaoui, Rony; Friderici, Jennifer; Visintainer, Paul; Lindenauer, Peter K.; Lagu, Tara; Desilets, David J.

doi:10.1111/liv.12225

Cited by 31 publications

(45 citation statements)

References 17 publications

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“…Checklists or decision support within electronic order entry systems may also help reduce the low rates of paracentesis seen in our and prior studies. 4, 6, 7 …”

Section: Resultsmentioning

confidence: 99%

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Use of paracentesis in hospitalized patients with decompensated cirrhosis and ascites: Opportunities for quality improvement

Brooling

Ghaoui

Lindenauer

et al. 2014

Journal of Hospital Medicine

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“…Checklists or decision support within electronic order entry systems may also help reduce the low rates of paracentesis seen in our and prior studies. 4, 6, 7 …”

Section: Resultsmentioning

confidence: 99%

“…3 Despite evidence that in-hospital mortality is reduced in those patients who receive paracentesis in a timely manner, 4, 5 only 40–60% of eligible patients receive paracentesis. 4, 6, 7 We aimed to describe clinical predictors of paracentesis and use of antibiotics following an episode of SBP in patients with decompensated cirrhosis and ascites.…”

mentioning

confidence: 99%

Use of paracentesis in hospitalized patients with decompensated cirrhosis and ascites: Opportunities for quality improvement

Brooling

Ghaoui

Lindenauer

et al. 2014

Journal of Hospital Medicine

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“…In both the US and Europe, the incidence of readmission within 7 days of discharge for patients with cirrhosis has been reported to be 14% and reaches 30–40% by 30 days. (3, 4, 7) Beyond costs, hospitalization for decompensated cirrhosis is associated with an important negative effect on quality of life. (8) Unsurprisingly, preventable readmissions are an increasing focus for clinicians, patients, payors and regulatory agencies alike.…”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis

Tapper

Finkelstein

Mittleman

et al. 2016

Clinical Gastroenterology and Hepatology

134

119

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Background 30-day readmissions for hospitalized patients with cirrhosis are common, particularly for patients with hepatic encephalopathy (HE). Methods We performed a prospective pre-post study from 2010–2013 to assess the impact of a quality improvement (QI) protocol on 30-day readmissions to a transplant center’s liver unit. The intervention included a yearlong control period, a handheld checklist and an “electronic” phase incorporating checklist items into the electronic provider order entry system. The intervention included goal-directed lactulose therapy and universal rifaximin for overt HE as well as prompts for antibiotic prophylaxis of spontaneous bacterial peritonitis (SBP). 30-day readmission trends were compared to non-cirrhotic patients admitted to hospitalists and patients with decompensated cirrhosis at another center. Results 824 patients were admitted 1720 times. The average model for end-stage liver disease score on admission was 17.7 ± 7.4. The electronic phase was associated with 40% lower adjusted odds of 30-day readmission compared to control, both overall and for patients with HE. The proportion of admissions for ≥ grade 2 HE that resulted in a readmission fell from 48.9% (66/135) in the control period to 26.0% (27/104) in the electronic phase (p = 0.0003). Rifaximin use for HE and antibiotic secondary prophylaxis of SBP (on discharge) were associated with lower adjusted odds of readmission (respective OR 0.39 and 0.40). The electronic phase was associated with a lower length of stay (beta coefficient −1.34 95% CI: −2.38 – −0.32, p = 0.01). Conclusion A QI initiative using electronic decision support reduced 30-day readmissions for patients with cirrhosis.

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“…before MC, adherence to QI for this group has been reported elsewhere (4). Both cohorts included all patients aged > 18 years with DC admitted to Baystate Medical Center, a tertiary-care medical center in Western Massachusetts.…”

Section: Methodsmentioning

confidence: 75%

“…We assessed whether MC was associated with better care and improved outcomes (hospitalization length of stay (LOS), 30-day readmission, and inpatient mortality) when compared to usual care (UC) (4). …”

Section: Introductionmentioning

confidence: 99%

Outcomes associated with a mandatory gastroenterology consultation to improve the quality of care of patients hospitalized with decompensated cirrhosis

Ghaoui

Friderici

Desilets

et al. 2014

Journal of Hospital Medicine

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Background & Aims Patients with decompensated cirrhosis (DC) have significant morbidity, and resource utilization. In a cohort of patients with DC undergoing usual care (UC) in 2009, we demonstrated that quality indicators (QI) were met less than 50% of the time. We established a mandatory gastroenterology consultation (MC) to improve the care of patients with DC. We sought to evaluate the impact of the MC intervention on adherence to QI, and compared outcomes to UC. Methods Prospective cohort study with historic control examining all admissions in a year for DC at an academic medical center. All admissions were seen by a gastroenterologist encouraged to implement QI (MC). Scores were calculated for each group per admission as the proportion of QI met vs. QI for which the patient was eligible. QI scores were examined as a function of group assignment multivariable fractional logit regression. We evaluated the impact of the intervention on compliance with QIs, length of stay (LOS), 30-day readmission, and inpatient death. Results 303 patients were observed in 695 hospitalizations (149 patients in 379 admissions (UC); 154 patients in 316 admissions (MC)). The QI score was significantly higher in the MC group than the UC group (77.0% vs. 46.0%, p<0.001), reflecting a better management of ascites and documentation of transplant evaluation. The management of variceal bleeding improved also but did not reach statistical significance. Conclusion The MC intervention was associated with greater adherence to recommended care but was not powered to detect difference in LOS, readmission or mortality rates.

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Measurement of the quality of care of patients admitted with decompensated cirrhosis

Cited by 31 publications

References 17 publications

Use of paracentesis in hospitalized patients with decompensated cirrhosis and ascites: Opportunities for quality improvement

Use of paracentesis in hospitalized patients with decompensated cirrhosis and ascites: Opportunities for quality improvement

A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis

Outcomes associated with a mandatory gastroenterology consultation to improve the quality of care of patients hospitalized with decompensated cirrhosis

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