Faculty Collaboration Database

Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems. Dig Dis Sci 2016 Oct;61(10):2857-2867

Date

06/13/2016

Pubmed ID

27289585

DOI

10.1007/s10620-016-4221-3

Scopus ID

2-s2.0-84987673664 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Evidence-based guidelines and quality indicators for cirrhosis care have been established. Whether there are variations in adherence to these cirrhosis standards at different specialty settings has not been investigated.

AIMS: To evaluate the quality of cirrhosis care delivered at diverse hepatology care sites.

METHODS: We conducted a retrospective study comparing the quality of care at three hepatology specialty clinics: a Faculty Practice, safety-net hospital, and Veterans Affairs (VA) Medical Center. Consecutive patients with cirrhosis (85 Faculty Practice, 81 safety-net, and 76 VA) between 2010 and 2011 were included. Median follow-up was 2.3 years. Outcome measures were the adherence to six cirrhosis-specific quality-of-care indicators.

RESULTS: Adherence to hepatitis A and B vaccinations was highest at the safety-net hospital, 81 and 74 %, compared to 46 and 30 % at the Faculty Practice (P < .001). Adherence to yearly hepatocellular carcinoma surveillance was highest at the safety-net site (79 %) versus the VA (50 %) and Faculty Practice (42 %), P = .001. In contrast, screening rates for esophageal varices were 75 % at the Faculty Practice and only 58 and 43 % at the VA and safety-net sites, respectively (P < .001). Liver transplant discussions were documented most consistently at the Faculty Practice (82 %) compared to the safety-net site (53 %) and VA (54 %), P < .001.

CONCLUSIONS: Disparities in cirrhosis quality measures existed by site. Strategies to overcome these disparities need to be developed to improve the delivery of quality cirrhosis care as we face a rise in cirrhosis-related complications over the next two decades.

Author List

Sclair SN, Carrasquillo O, Czul F, Trivella JP, Li H, Jeffers L, Martin P

Author

Juan Pablo Trivella MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Carcinoma, Hepatocellular
Cohort Studies
Delivery of Health Care
Disease Management
Early Detection of Cancer
End Stage Liver Disease
Endoscopy, Digestive System
Esophageal and Gastric Varices
Faculty, Medical
Female
Gastroenterologists
Gastroenterology
Guideline Adherence
Hepatitis A
Hepatitis A Vaccines
Hepatitis B
Hepatitis B Vaccines
Humans
Liver Cirrhosis
Liver Neoplasms
Liver Transplantation
Male
Middle Aged
Practice Guidelines as Topic
Quality of Health Care
Retrospective Studies
Severity of Illness Index
United States
United States Department of Veterans Affairs