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Quality Measures, All-Cause Mortality, and Health Care Use in a National Cohort of Veterans With Cirrhosis.
Serper, Marina; Kaplan, David E; Shults, Justine; Reese, Peter P; Beste, Lauren A; Taddei, Tamar H; Werner, Rachel M.
Afiliação
  • Serper M; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.
  • Kaplan DE; Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Shults J; Leonard Davis Institute of Health Economics, Philadelphia, PA.
  • Reese PP; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.
  • Beste LA; Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Taddei TH; Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA.
  • Werner RM; Leonard Davis Institute of Health Economics, Philadelphia, PA.
Hepatology ; 70(6): 2062-2074, 2019 12.
Article em En | MEDLINE | ID: mdl-31107967
Decompensated cirrhosis is associated with high morbidity and mortality. However, no standardized quality measures (QMs) have yet been adopted widely. The Veterans Affairs (VA) Advanced Liver Disease Technical Advisory Group recently developed a set of six internal QMs to guide quality improvement efforts in cirrhosis in the domains of access to care, hepatocellular carcinoma surveillance, variceal surveillance, quality of inpatient care for upper gastrointestinal bleeding, and cirrhosis-related rehospitalizations. We aimed to (1) quantify adherence to cirrhosis QMs and (2) determine whether adherence was associated with all-cause mortality and health care use within a large national cohort of veterans with cirrhosis. We performed a retrospective study using data from the Veterans Outcomes and Costs Asociated with Liver Disease cohort of 121,129 patients newly diagnosed with cirrhosis from January 1, 2008, to December 31, 2016, at 128 VA facilities. The mean follow-up time was 2.7 years (interquartile range, 1.1-5.1 years). Adherence to outpatient access to specialty care was 71%, variceal surveillance was 32%, and early postdischarge care was 54%. In adjusted analyses, outpatient access to specialty care (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.78-0.82), hepatocellular carcinoma surveillance (HR, 0.92; 95% CI, 0.90-0.95), variceal surveillance (HR, 0.93; 95% CI, 0.89-0.99), and early postdischarge care (HR, 0.57; 95% CI, 0.54-0.60) were associated with lower all-cause mortality. Readmissions after 30 days (HR, 1.53; 1.46-1.60) and 90 days (HR, 1.88; 95% CI, 1.54-1.70) were associated with higher all-cause mortality. Higher adherence to QMs was also associated with lower inpatient health care use. Conclusion: Five of the six proposed VA cirrhosis QMs were measurable using existing data sources, associated with mortality and health care use, and may be used to guide future quality improvement efforts in cirrhosis.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Cirrose Hepática Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Hepatology Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Qualidade da Assistência à Saúde / Cirrose Hepática Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Hepatology Ano de publicação: 2019 Tipo de documento: Article