title: Impact of physician specialty on quality care for patients hospitalized with decompensated cirrhosis.
abstract: BACKGROUND
  Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis.
  
  
  METHODS
  We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death.
  
  
  RESULTS
  Overall, 147 admissions (59.5%) received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006), and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03) and hepatic encephalopathy (100% vs. 63%, P = .005). Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023). Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02), and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02).
  
  
  CONCLUSIONS
  Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Vermont College of Medicine, Burlington, Vermont, United States of America; University of Vermont Medical Center, Burlington, Vermont, United States of America.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lim
authors.affiliation: Division of Gastroenterology and Hepatology, University of Vermont College of Medicine, Burlington, Vermont, United States of America; University of Vermont Medical Center, Burlington, Vermont, United States of America.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Lidofsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D020445:Hospitalists; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008511:Medicine; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome
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