Hospitalist-based Healthcare Delivery Model in Cirrhosis - A Comparative Effectiveness Study in Management of Upper Gastrointestinal Bleeding
AASLD LiverLearning®. Tey K. Nov 14, 2016; 144656
Topic: Health Care Delivery/Quality/Effectiveness
Kai Rou Tey
Kai Rou Tey

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TITLE: Hospitalist-based Healthcare Delivery Model in Cirrhosis - A Comparative Effectiveness Study in Management of Upper Gastrointestinal Bleeding

2015 Arizona Health Sciences Career Development Award

Background: The healthcare burden posed by cirrhosis is amplified by significant gaps in the quality of care delivered. When hospitalized, patients with cirrhosis are managed by different care models, i.e the hospitalist-based model or “traditional” model, comprised of primary care and subspecialty providers who practice inpatient medicine. There is limited data on whether different inpatient healthcare delivery models can influence the quality of care delivered to cirrhotic patients.

Aim: We aim to describe the adherence to evidenced based measures during inpatient management of patients with cirrhosis by different healthcare providers and if hepatology consultation is associated with higher adherence.

Methods: Our study cohort comprised of adult cirrhotic patients with upper gastrointestinal bleeding who are admitted to a large academic transplant center between 7/1/2013 to 9/30/2015 screened by admitting diagnoses. Using previously published quality indicators (QIs) by Kanwal et al., 2010, we compared the cohort cared for by hospitalist to those cared for by other providers.

Results: We identified 177 patients for inclusion, 54 in hospitalist and 66 in traditional care groups and 57 patients with care in the intensive care unit (ICU). The mean age was 53.8 year old, 67% were male, mean MELD-Na on admission of 18.8. Overall, the adherence of QIs measures was 48.6% to 93.8%, and individual adherence rates for each QIs as shown in table 1. We also did a subgroup analysis, which demonstrated Hepatology consult led to greater adherence to the QI scores. However, mean length of stay (5.68 vs 4.93 days) and mean total cost ($50310 vs $38790) was higher for traditional group than hospitalist group. Readmission rate within 30 days was significantly lower in hospitalist group compared to traditional group (20.4% VS 28.8%)

Conclusion: Our findings provided insight on differences and inconsistency of quality of care received by inpatients with cirrhosis, influenced by the the inpatient care delivery model and moderated by hepatology consultation. This data will inform ideal methods of health-care delivery to those with decompensated cirrhosis and ascertain methods to close the quality gap between providers.
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