Year 2020 / Volume 112 / Number 11
Original
Quality of care provided to outpatients with hepatic cirrhosis in a teaching hospital

826-831

DOI: 10.17235/reed.2020.6811/2019

Xavier Xiol Quingles, Sílvia Salord Vila, Alberto Amador Navarrete, Carme Baliellas Comellas, Alba Cachero Ros, Rosa Rota Roca, Valeria Pérez Campuzano, José Castellote Alonso,

Abstract
Introduction: a set of indicators to measure the quality of care of cirrhotic patients has been established and previously published studies report an adherence rate to clinical guide indications of 40-80 %. Objective: to assess the adherence to quality indicators in a tertiary teaching hospital. Methods: a retrospective observational study was performed of all cirrhotic outpatients seen during one semester in 2017. The charts were studied of 324 patients and quality indicators related to five domains were collected. An overall adherence to 14 quality indicators was recorded and analyzed based on the attending physician’s experience. Results: the results were excellent (more than 90 % adherence) for quality indicators related to prophylaxis of variceal bleeding and documentation of cirrhosis etiology, acceptable (60-90 % adherence) for hepatocellular carcinoma screening and disease severity assessment, and poor (less than 50 %) for vaccinations. Residents had significantly better results than experienced physicians in etiology, disease severity assessment and two indicators of prophylaxis of bleeding. Experienced physicians only presented a better adherence to hepatocellular carcinoma screening. Conclusions: despite excellent results for some quality indicators, most required improvement, especially vaccinations. The quality of care achieved by residents is equal to and even better than that of experienced physicians. Measuring quality of care is essential to analyze and improve the health care of cirrhotic outpatients and may be a useful tool for supervising specialists in training.
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References
1.- The European Association for the Study of the Liver. EASL Clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69:406-460.
2.- D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic
indicators of survival in cirrhosis: a systematic review of 118 studies. J
Hepatol 2006; 44: 217–231.
3.- de Franchis R, on behalf of the Baveno VI Faculty. Expanding consensus in portal hypertension. Report of the Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension J Hepatol 2015; 63: 743–752
4- EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. European Association for the Study of the Liver. J Hepatol. 2018; 69: 182-236.
5.- Fukui H, Saito H, Ueno Y, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol 2016 51: 629–650
6.- Tripathi D, Stanley AJ, Hayes PC, et al U.K. guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015; 64: 1680-704
7.-Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma. Current best practice and future direction. Gastroenterology. 2019; 157: 54-64
8.- Neff GW, Kemmer N, Duncan, et al . Update on the management of cirrhosis – focus on cost-effective preventative strategies. Clinico Economics and Outcomes Research 2013; 5: 143–152
9.- Mittal S, Kanwal F, Ying J, et al. Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: A United States cohort. J Hepatol. 2016; 65:1148-1154
10.- Kanwal F, Volk M, Singal AG, et al. Improving quality of health care for patients with cirrhosis. Gastroenterology. 2014; 147: 1204-7
11.- López-Picazo J, Alberca F, Sánchez AQ et al. Indicadores de calidad en endoscopia digestiva: introducción a los indicadores comunes de estructura, proceso y resultado. Rev Esp Enferm Dig 2017; 109: 435-450
12.- Kanwal F, Kramer J, Asch SM, et al. An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. Clin Gastroenterol Hepatol. 2010; 8: 709–717.
13.- Kanwal F, Tapper EB, Ho C, et al. Development of quality measures in cirrhosis by the practice metrics committee of the American Association for the Study of Liver Diseases. Hepatology. 2019; 69: 1787-1797
14.- Dhanasekaran R, Talwalkar JA. Quality of cancer care in patients with cirrhosis and hepatocellular carcinoma. Curr Gastroenterol Rep 2015 17: 34
15.- Hernandez B, Hasson N, Cheung R. Hepatitis C performance measure on hepatitis A and B vaccination. Missed opportunities?. Am J Gastroenterol 2009; 104: 1961-67.
16.- Bassett JT, Volk ML. Can quality of care for patients with cirrhosis be measured? Dig Dis Sci 2011 56: 3488–3491
17.- Kanwal F, Kramer JR, Buchanan P, et al The quality of care provided to patients with cirrhosis and ascites in the department of veterans affairs. Gastroenterology 2012; 143: 70–77
18.- Ghaoui R, Friderici J, Visintainer P, et al. Measurement of the quality of care of patients admitted with decompensated cirrhosis. Liver Int. 2014; 34: 204-10.
19.- Buchanan PM, Kramer JR, El-Serag HB, et al. The quality of care provided to patients with varices in the department of Veterans Affairs. The Am J Gastroenterol 2014; 109: 934-940.
20.- Lim N, Lidofsky SD. Impact of Physician Specialty on Quality Care for Patients Hospitalized with Decompensated Cirrhosis. PLoS One. 2015; 10: e0123490.
21.- Sclar SN, Carrasquillo O, Czul F, et al. Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems. Dig Dis Sci 2016; 61: 2857–2867
22.- Tapper EB. Building Effective Quality Improvement Programs for Liver
Disease: A Systematic Review of Quality Improvement Initiatives. Clin Gastroenterol Hepatol. 2016; 14: 1256-1265.
23.- Vaughn VM, Saint S, Krein SL, et al. Characteristics of healthcare organisations struggling to improve quality; results from a systematic review of quality studies. BMJ Qual Saf 2019; 28: 74–84.
24.- BOE-A-2009-16993: https://www.boe.es/eli/es/o/2009/10/09/sas285 (in Spanish)
25- de Franchis R. Evolving consensus in portal hypertension. Report of the
Baveno IV consensus workshop on methodology of diagnosis and therapy in
portal hypertension. J Hepatol 2005; 43: 167–176.
26.- Majeed A, Allwood D, Foley K, Bindman A. Healthcare outcomes and quality in the NHS: how do we compare and how might the NHS improve? BMJ 2018; 362: k3036
27.- Donabedian A. Evaluating the Quality of Medical Care. The Milbank Quarterly 2005; 83: 691–729
28.- Stickel F, Datz C, Hampe J, et al. Pathophysiology and Management ofAlcoholic Liver Disease: Update 2016. Gut Liver. 2017; 11: 173-188
29.- Capdevila O, Pallares, R, GaaruI, et al. Pneumococcal peritonitis in adult patients: report of 64 cases with special reference to emergence of antibiotic resistance. Arch Intern Med 2001; 161: 1742-8
30.- Picazo JJ, González-Romo F, García Rojas A, et al. Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Rev Esp Quimioter 2013; 26: 232-252
31- Leise MD, Talwalkar JA. Immunizations in Chronic Liver Disease: What should be done and what is the evidence. Curr Gastroenterol Rep 2013; 15: 300
32.- Zhao C, Jin M, Le RH, et al. Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta-analysis of a complex issue. Liv Int. 2018; 38: 503–514.
33 .- Jones AC, Shipman SA, Ogrinc G. Key characteristics of successful
quality improvement curricula in physician education: a realist review BMJ
Qual Saf 2015; 24: 77–88.
34.-Tapper EB, Finkelstein D, Mittleman MA, et al. A Quality improvement initiative reduces 30-day rate of readmission for patients with cirrhosis. Clin Gastroenterol Hepatol. 2016; 14: 753-9
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Xiol Quingles X, Salord Vila S, Amador Navarrete A, Baliellas Comellas C, Cachero Ros A, Rota Roca R, et all. Quality of care provided to outpatients with hepatic cirrhosis in a teaching hospital. 6811/2019


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Publication history

Received: 12/12/2019

Accepted: 23/02/2020

Online First: 15/10/2020

Published: 10/11/2020

Article revision time: 68 days

Article Online First time: 308 days

Article editing time: 334 days


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