Adherence to quality indicators and hospital outcomes for patients with decompensated cirrhosis: An observational study.

BACKGROUND

Quality indicators (QIs) exist for the care of patients with cirrhosis. We retrospectively examined the records of patients admitted to a large academic tertiary care centre for adherence to QIs and examined for an association between QI adherence and hospital outcomes.

METHODS

We conducted a cross-sectional study of all patients with decompensated liver cirrhosis admitted to a large academic tertiary care centre over a 2-year period (2014-2016). Medical records of 522 patients were examined for 17 QIs related to inpatient cirrhosis care and adherence-judged using three different standards: 100% adherence, 70% adherence, or the QI score as a continuous variable. Linear and logistic regression was used to evaluate the association between QI score and length of stay (LOS), 30-day readmissions, and inpatient mortality, respectively.

RESULTS

Adherence to QIs was variable (range 20%-95%). Overall, adherence to QIs relating to variceal bleeding was higher than adherence to indicators related to hepatic encephalopathy and spontaneous bacterial peritonitis. There was weak evidence for a decreased odds of 30-day readmission when more QIs were met, regardless of the method used to quantify adherence (100% standard OR 0.53 [95% CI 0.26-1.09, p = .09], 70% standard OR 0.58 [95% CI 0.32-1.06, p = .08], continuous method OR 0.90 [95% CI 0.81-1.01, p = .07]). There was no observed relationship between mortality and QI adherence and equivocal evidence for an association between QI adherence and LOS.

CONCLUSIONS

Adherence to QIs related to inpatient care of decompensated cirrhosis may be associated with decreased 30-day readmissions.