Monday, November 5, 2012

Quality indicator adherence did not impact readmission, mortality in liver disease

November 5, 2012
LAS VEGAS — High adherence to quality of care indicators for patients with chronic liver disease was not associated with reductions in hospital readmission rates within 30 days or mortality in a study presented at the 2012 American College of Gastroenterology Annual Scientific Meeting.

Researchers performed a retrospective chart review of 306 patients admitted to the Cleveland Clinic liver service for chronic liver disease between August 2008 and September 2010, including all outpatient and inpatient incidence through May 2012. Adherence to the following practice guidelines was established:

  • P1: “Antibiotics within 24 hours if patient has GI bleeding”
  • P2: “Empiric antibiotics within 6 hours of test if ascites and PMNs >250”
  • P3: “Salt restriction and diuretics for ascites and normal renal function”
  • P4: “Outpatient prophylactic antibiotics if total protein <1.1 and bilirubin >2.5”
  • P5: “Nonselective beta-blocker or endoscopic variceal ligation within 1 month if patient has cirrhosis, no GI bleeding and medium-to-large varices”
  • P6: “Somatostatin or analogues within 12 hours for variceal bleeding”
  • P7: “Upper endoscopy within 24 hours for upper GI bleeding”
  • P8: “Prevention of recurrence of variceal hemorrhage”
  • P9: “Oral dissacharide for encephalopathy”
“Previous studies have demonstrated risk factors for readmission in patients with liver disease,” the researchers wrote. “No studies have assessed whether adherence to quality indicators decreases 30-day readmissions and 6-month mortality.”

Maged K. Rizk
Readmission within 30 days occurred in 27.8% of cases within the cohort. Adherence to the assessed guidelines was generally high, with the lowest overall adherence rate observed for guideline P6 (74.4% of cases). No significant difference in adherence to any of the guidelines was noted between patients who did and did not require readmission within 30 days. Investigators also observed no associations between guideline adherence and 6-month mortality risk.

The researchers concluded that adherence to quality indicators is increasing for the treatment of chronic liver disease, but it does not significantly impact readmission or mortality rates.

“The data is consistent with what was seen in surgical literature when they tried to decrease surgical site infections,” researcher Maged K. Rizk, MD, director of the Chronic Abdominal Pain Center in the gastroenterology and hepatology department of Cleveland Clinic, told “Maybe we need to consider looking at not just adherence to individual quality indicators, but at quality indicator bundles. We need to also consider that, although decent, there is still room for improvement for adherence.”

For more information:
Ghobrial M. #30: Adherence to Quality Indicators in Patients With Liver Disease is Not Sufficient to Reduce 30-Day Readmissions or Mortality. Presented at: the 2012 American College of Gastroenterology Annual Scientific Meeting; Oct. 19-24, Las Vegas.

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