| Popis: |
BACKGROUND: Cirrhosis is an increasingly prevalent condition associated with growing healthcare costs and resource utilization related to several possible complications of the disease including ascites, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), hepatic encephalopathy (HE), and variceal bleeding (VB). Inconsistencies are known to exist in the management of patients with cirrhosis. Evidence-based quality indicators (QIs) recently developed to help clinicians guide management of cirrhosis are now correlated with outcomes such as readmission and mortality. AIMS: We seek to evaluate adherence to defined QIs at TOH and measure the association with subsequent outcomes such as length of stay, inpatient mortality, and 30-day readmission rates. METHODS: Patients with decompensated cirrhosis admitted to a medical service at TOH between July 2014–2016 were identified using ICD codes, and a retrospective cohort study using electronic charts is underway. Predictive validity of the QIs used is being assessed by measuring the relationship between QI adherence and patient outcomes. RESULTS: Of the 302 admissions reviewed to date, 291 were visits related to decompensated cirrhosis (190 unique patients). Among those, mean length of stay was 12.2 days (median 6.2, IQR 3.2–14.7) and the 30-day readmission rate was 24.4%. Gastroenterology consultations were obtained in 47.8% of visits. Among patients with variceal upper GI bleeding, the following QIs were met: endoscopy performed within 24h in 81.0%, octreotide instituted within 12h in 86.8%, and antibiotic prophylaxis given in 94.1%. Among patients with ascites, paracentesis was performed during admission in 60.8%, albumin was infused after large-volume paracentesis in 88.7%, spontaneous bacterial peritonitis (SBP) was treated with appropriate antibiotics in 96.4%, and secondary antibiotic prophylaxis post-SBP was prescribed in 38.5%. In patients with overt hepatic encephalopathy, a search for and correction of all precipitating factors was documented in 35.2%, while medical therapy at discharge was appropriate in 64.8% of cases. CONCLUSIONS: Patients admitted to TOH with decompensated cirrhosis have prolonged stay in hospital and high readmission rates. Adherence to predefined QIs is variable and may be related to both patient and provider factors (understanding, education, coordination and timeliness of care). Focused interventions are warranted in several areas to help improve outcomes. FUNDING AGENCIES: None |
