Improvement of quality of care provided to outpatients with hepatic cirrhosis after an educational intervention.


Journal

European journal of gastroenterology & hepatology
ISSN: 1473-5687
Titre abrégé: Eur J Gastroenterol Hepatol
Pays: England
ID NLM: 9000874

Informations de publication

Date de publication:
15 Apr 2024
Historique:
medline: 16 4 2024
pubmed: 16 4 2024
entrez: 16 4 2024
Statut: aheadofprint

Résumé

A set of indicators has been reported to measure the quality of care for cirrhotic patients, and previously published studies report variable adherence rates to these indicators. This study aimed to assess the quality of care provided to cirrhotic outpatients before and after an educational intervention by determining its impact on adherence to quality indicators. We conducted a quasi-experimental, cross-sectional study including 324 cirrhotic patients seen in 2017 and 2019 at a tertiary teaching hospital in Spain. Quality indicators were assessed in five domains: documentation of cirrhosis etiology, disease severity assessment, hepatocellular carcinoma (HCC) screening, variceal bleeding prophylaxis, and vaccination. After identifying areas for improvement, an educational intervention was implemented. A second evaluation was performed after the intervention to assess changes in adherence rates. Before the intervention, adherence rates were excellent (>90%) for indicators related to variceal bleeding prophylaxis and documentation of cirrhosis etiology, acceptable (60-80%) for HCC screening and disease severity assessment, and poor (<50%) for vaccinations. After the educational intervention, there was a statistically significant improvement in adherence rates for eight indicators related to HCC screening (70-90%), disease severity assessment (90%), variceal bleeding prophylaxis (>90%), and vaccinations (60-90%). Our study demonstrates a significant improvement in the quality of care provided to cirrhotic outpatients after an educational intervention. The findings highlight the importance of targeted educational interventions to enhance adherence to quality indicators in the management of cirrhosis.

Identifiants

pubmed: 38625820
doi: 10.1097/MEG.0000000000002778
pii: 00042737-990000000-00344
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Références

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.
European Association for the Study of the Liver. EASL clinical practice guidelines. management of hepatocellular carcinoma. J Hepatol 2018; 69:182–236.
Fukui H, Saito H, Ueno Y, Uto H, Obara K, Sakaida I, et al. Evidence-based clinical practice guidelines for liver cirrhosis 2015. J Gastroenterol 2016; 51:629–650.
Tripathi D, Stanley AJ, Hayes PC, Patch D, Millson C, Mehrzad H, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut 2015; 64:1680–1704.
Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017; 65:310–335.
Kanwal F, Singal AG. Surveillance for hepatocellular carcinoma. Current best practice and future direction. Gastroenterology 2019; 157:54–64.
Neff GW, Kemmer N, Duncan C, Alsina A. Update on the management of cirrhosis – focus on cost-effective preventative strategies. Clinicoecon Outcomes Res 2013; 5:143–152.
Mittal S, Kanwal F, Ying J, Chung R, Sada YH, Temple S, et al. Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: a United States cohort. J Hepatol 2016; 65:1148–1154.
Tapper EB, Parikh ND. The future of quality improvement in cirrhosis. Liver Transpl 2001; 10:1478–1489.
Bassett JT, Volk ML. Can quality of care for patients with cirrhosis be measured? Dig Dis Sci 2011; 56:3488–3491.
Dhanasekaran R, Talwalkar JA. Quality of cancer care in patients with cirrhosis and hepatocellular carcinoma. Curr Gastroenterol Rep 2015; 17:34.
Kanwal F, Volk M, Singal A, Angeli P, Talwalkar J. Improving quality of health care for patients with cirrhosis. Gastroenterology 2014; 147:1204–1207.
Kanwal F, Kramer J, Asch SM, El-Serag H, Spiegel BM, Edmundowicz S, et al. An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. Clin Gastroenterol Hepatol 2010; 8:709–717.
Kanwal F, Tapper EB, Ho C, Asrani SK, Ovchinsky N, Poterucha J, 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.
Hernández B, Hasson N, Cheung R. Hepatitis C performance measure on hepatitis A and B vaccination. Missed opportunities? Am J Gastroenterol 2009; 104:1961–1967.
Kanwal F, Kramer JR, Buchanan P, Asch SM, Assioun Y, Bacon BR, et al. The quality of care provided to patients with cirrhosis and ascites in the Department of Veterans Affairs. Gastroenterology 2012; 143:70–77.
Ghaoui R, Friderici J, Visintainer P, Lindenauer PK, Lagu T, Desilets D. Measurement of the quality of care of patients admitted with decompensated cirrhosis. Liver Int 2014; 34:204–210.
Buchanan PM, Kramer JR, El-Serag HB, Asch SM, Assioun Y, Bacon BR, et al. The quality of care provided to patients with varices in the Department of Veterans Affairs. Am J Gastroenterol 2014; 109:934–940.
Lim N, Lidofsky SD. Impact of physician specialty on quality care for patients hospitalized with decompensated cirrhosis. PLoS One 2015; 10:e0123490.
Sclair SN, Carrasquillo O, Czul F, Trivella JP, Li H, Jeffers L, et al. Quality of care provided by hepatologists to patients with cirrhosis at three parallel health systems. Dig Dis Sci 2016; 61:2857–2867.
Tapper EB. Building effective quality improvement programs for liver disease: a systematic review of quality improvement initiatives. Clin Gastroenterol Hepatol 2016; 14:1256–1265.e3.
Xiol X, Salord S, Amador A, Baliellas C, Cachero A, Rota R, et al. Quality of care provided to outpatients with hepatic cirrhosis in a teaching hospital. Rev Esp Enferm Dig 2020; 112:826–831.
Boletín Oficial del Estado. Programa formativo de la Especialidad de Aparato Digestivo en España. BOE-A-2009-16993. 2009; 258:89582–89604. https://www.boe.es/eli/es/o/2009/10/09/sas2854
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.
de Franchis R; 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.
World Health Organization. (2019). International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. https://icd.who.int/. License: CC BY-ND 3.0 IGO.
Reynolds C, Esrailan E, Hommes D. Quality improvement in gastroenterology: a systematic review of practical interventions for clinicians. Dig Dis Sci 2018; 63:2507–2518.
Masson CL, Delucchi KL, McKnight C, Hettema J, Khalili M, Min A, et al. A randomized trial of a hepatitis care coordination model in methadone maintenance treatment. Am J Public Health 2013; 103:e81–e88.
Aberra FB, Essenmacher M, Fisher N, Volk ML. Quality improvement measures lead to higher surveillance rates for hepatocellular carcinoma in patients with cirrhosis. Dig Dis Sci 2013; 58:1157–1160.
Kennedy NA, Rodgers A, Altus R, McCormick R, Wundke R, Wigg AJ. Optimization of hepatocellular carcinoma surveillance in patients with viral hepatitis: a quality improvement study. Intern Med J 2013; 43:772–777.
Beste LA, Ioannou GN, Yang Y, Chang MF, Ross D, Dominitz JA. Improved surveillance for hepatocellular carcinoma with a primary care-oriented clinical reminder. Clin Gastroenterol Hepatol 2015; 13:172–179.
Singal AG, Tiro JA, Murphy CC, Marrero JA, McCallister K, Fullington H, et al. Mailed outreach invitations significantly improve HCC surveillance rates in patients with cirrhosis: a randomized clinical trial. Hepatology 2019; 69:121–130.
Wundke R, Altus R, Sandford J, Wigg A. Improving management of oesophageal varices in patients with cirrhosis. Qual Saf Health Care 2010; 19:536–541.
Loy V, Kwiatt J, Dodda A, Martin E, Dua A, Saeian K. Performance feedback improves compliance with quality measures. Am J Med Qual 2016; 31:118–124.
Cahill JA, Rizvi S, Saeian K. Assessment of adherence to baseline quality measures for cirrhosis and the impact of performance feedback in a regional VA medical center. Am J Med Qual 2018; 33:262–268.
Tapper EB, Asrani SK. The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care. J Hepatol 2020; 73:441–445.

Auteurs

Alberto Amador (A)

Hepatology Unit, Gastroenterology Department, Hospital Universitari de Bellvitge, Institut Català de la Salut, Hepatobiliary and Pancreatic Diseases Research Group, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

Classifications MeSH