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 journalArticlepeer-review

6 Scopus 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.

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

Keywords

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

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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