Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems

Seth N. Sclair, Olveen Carrasquillo, Frank Czul, Juan P. Trivella, Hua Li, Lennox J Jeffers, Paul Martin

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2857-2867
Number of pages11
JournalDigestive Diseases and Sciences
Volume61
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Quality of Health Care
Fibrosis
Veterans
Health
Safety-net Providers
Safety
Gastroenterology
Hepatitis A
Esophageal and Gastric Varices
Gastroenterologists
Hepatitis B
Hepatocellular Carcinoma
Vaccination
Retrospective Studies
Outcome Assessment (Health Care)
Guidelines
Transplants
Liver

Keywords

  • Chronic liver disease
  • Cirrhosis
  • Guideline adherence
  • Healthcare disparities
  • Physician quality reporting system
  • Quality indicators

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems. / Sclair, Seth N.; Carrasquillo, Olveen; Czul, Frank; Trivella, Juan P.; Li, Hua; Jeffers, Lennox J; Martin, Paul.

In: Digestive Diseases and Sciences, Vol. 61, No. 10, 01.10.2016, p. 2857-2867.

Research output: Contribution to journalArticle

Sclair, Seth N. ; Carrasquillo, Olveen ; Czul, Frank ; Trivella, Juan P. ; Li, Hua ; Jeffers, Lennox J ; Martin, Paul. / Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems. In: Digestive Diseases and Sciences. 2016 ; Vol. 61, No. 10. pp. 2857-2867.
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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.",
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AU - Sclair, Seth N.

AU - Carrasquillo, Olveen

AU - Czul, Frank

AU - Trivella, Juan P.

AU - Li, Hua

AU - Jeffers, Lennox J

AU - Martin, Paul

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N2 - 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.

AB - 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.

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KW - Cirrhosis

KW - Guideline adherence

KW - Healthcare disparities

KW - Physician quality reporting system

KW - Quality indicators

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