title: Impact of gastroenterology consultation on the outcomes of patients admitted to the hospital with decompensated cirrhosis.
abstract: Managed care has strongly discouraged generalists from referring patients to specialists in an effort to reduce the costs of health care. The aim of this study was to compare patient outcomes when generalists work together with gastroenterologists or alone in the management of patients admitted to the hospital with decompensated cirrhosis. Consecutive patients admitted to the hospital with decompensated cirrhosis over a 1-year period were identified. We compared the length of stay, cost of hospitalization, incidence of hospital readmission, and mortality for patients who did and those who did not have a gastroenterology (GI) consultation. A GI consultation was requested for 107 of the 197 patients (54.3%). Patients who had a GI consultation had a significantly shorter length of stay (5.6 +/- 3.5 vs. 10.1 +/- 5.8 days, P <.001) and a lower cost of hospitalization ($6,004 +/- $4,994 vs. $10,006 +/- $6,183, P <.001) than those patients who were managed by generalists alone. The 30-day incidence of readmission (13.3% vs. 27.8%, P =.01) and mortality (7.5% vs. 16.7%, P =.045) were significantly lower in the GI consultation group. During a median follow-up of 618 days (range, 2-970), patients who had a GI consultation during hospitalization had a significantly longer time to hospital readmission (P <.001) and improved survival (P =.02) compared with those who were managed by generalists alone. In conclusion, for patients admitted to the hospital with decompensated cirrhosis, individuals who were managed by generalists in conjunction with gastroenterologists had better outcomes than those who were managed by generalists alone.
authors.affiliation: Department of Medicine and Division of Gastroenterology, VA New York Harbor Healthcare System, New York, NY 10010, USA. Edmund.Bini@med.va.gov
authors.forename: E J
authors.initials: EJ
authors.lastname: Bini
authors.forename: E H
authors.initials: EH
authors.lastname: Weinshel
authors.forename: R
authors.initials: R
authors.lastname: Generoso
authors.forename: L
authors.initials: L
authors.lastname: Salman
authors.forename: G
authors.initials: G
authors.lastname: Dahr
authors.forename: I
authors.initials: I
authors.lastname: Pena-Sing
authors.forename: T
authors.initials: T
authors.lastname: Komorowski
mesh_terms: D000368:Aged; D005194:Family Practice; D005260:Female; D005762:Gastroenterology; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012017:Referral and Consultation; D016896:Treatment Outcome