title: Measurement of the quality of care of patients admitted with decompensated cirrhosis.
abstract: OBJECTIVE
  Process-based quality measures are increasingly used to evaluate hospital performance. However, practices vary, and patients with cirrhosis are a challenge to manage, given their risks of mortality, morbidity, and resources utilization. In 2010, process-based quality measures were developed to improve the care of these patients. We examined adherence with these quality measures for a cohort of patients admitted with decompensated cirrhosis in 2009.
  
  
  METHODS
  We performed a retrospective analysis of all patients admitted to a tertiary-care hospital with decompensated cirrhosis in 2009 (n = 149,379) hospitalizations. Quality indicator (QI) scores were calculated for each admission as a fraction, i.e., the number of quality markers met divided by the number of possible quality indices, given the patient's presentation (range, 0-1). QI scores were correlated with patient characteristics and clinical outcomes (30-day readmission; inpatient death).
  
  
  RESULTS
  Quality indicators were met 45% of the time (95% confidence interval, 40-51%). In multivariable analysis, QI scores were significantly lower among non-English-speaking patients and those who had congestive heart failure. QI scores were higher among patients with gastrointestinal bleeding or encephalopathy-related admission to the hospital. QI scores were not associated with inpatient mortality or 30-day readmission.
  
  
  CONCLUSIONS
  There is substantial opportunity to improve the care of patients hospitalized for decompensated cirrhosis. Additional research is needed to identify effective strategies for closing gaps in care. Adherence to quality measures did not affect clinical outcomes, but if easily measured in other settings could be used to compare hospitals and practices.
authors.affiliation: Division of Gastroenterology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
authors.forename: Rony
authors.initials: R
authors.lastname: Ghaoui
authors.forename: Jennifer
authors.initials: J
authors.lastname: Friderici
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.forename: David
authors.initials: D
authors.lastname: Desilets
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: decompensated cirrhosis; healthcare quality; outcome research