title: Outcomes associated with a mandatory gastroenterology consultation to improve the quality of care of patients hospitalized with decompensated cirrhosis.
abstract: OBJECTIVE
  Patients with decompensated cirrhosis (DC) have significant morbidity and resource utilization. In a cohort of patients with DC undergoing usual care (UC) in 2009, we demonstrated that quality indicators (QI) were met <50% of the time. We established a gastroenterology mandatory consultation (MC) to improve the care of patients with DC. We sought to evaluate the impact of the MC intervention on adherence to QI, and compared outcomes to UC.
  
  
  METHODS
  This was a prospective cohort study with historic control examining all admissions in a year for DC at an academic medical center. All admissions were seen by a gastroenterologist encouraged to implement QIs (MC). Scores were calculated for each group per admission as the proportion of QIs met versus QIs for which the patient was eligible. QI scores were examined as a function of group assignment multivariable fractional logit regression. We evaluated the impact of the intervention on compliance with QIs, length of stay (LOS), 30-day readmission, and inpatient death.
  
  
  RESULTS
  Three hundred three patients were observed in 695 hospitalizations (149 patients in 379 admissions [UC]; 154 patients in 316 admissions [MC]). The QI score was significantly higher in the MC group than the UC group (77.0% vs 46.0%, P < 0.001), reflecting better management of ascites and documentation of transplant evaluation. The management of variceal bleeding improved also but did not reach statistical significance.
  
  
  CONCLUSIONS
  The MC intervention was associated with greater adherence to recommended care but was not powered to detect difference in LOS, readmission, or mortality rates.
authors.affiliation: Division of Gastroenterology, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Rony
authors.initials: R
authors.lastname: Ghaoui
authors.forename: Jennifer
authors.initials: J
authors.lastname: Friderici
authors.forename: David J
authors.initials: DJ
authors.lastname: Desilets
authors.forename: Tara
authors.initials: T
authors.lastname: Lagu
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.forename: Angelica
authors.initials: A
authors.lastname: Belo
authors.forename: Jorge
authors.initials: J
authors.lastname: Sotelo
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005762:Gastroenterology / Q000592:standards* / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D016896:Treatment Outcome