Quality of Care Provided by Hepatologists to Patients with Cirrhosis at Three Parallel Health Systems.
Evidence-based guidelines and quality indicators for cirrhosis care have been established. Whether there are variations in adherence to these cirrhosis standards at different specialty settings has not been investigated.



To evaluate the quality of cirrhosis care delivered at diverse hepatology care sites.



We conducted a retrospective study comparing the quality of care at three hepatology specialty clinics: a Faculty Practice, safety-net hospital, and Veterans Affairs (VA) Medical Center. Consecutive patients with cirrhosis (85 Faculty Practice, 81 safety-net, and 76 VA) between 2010 and 2011 were included. Median follow-up was 2.3 years. Outcome measures were the adherence to six cirrhosis-specific quality-of-care indicators.



Adherence to hepatitis A and B vaccinations was highest at the safety-net hospital, 81 and 74 %, compared to 46 and 30 % at the Faculty Practice (P < .001). Adherence to yearly hepatocellular carcinoma surveillance was highest at the safety-net site (79 %) versus the VA (50 %) and Faculty Practice (42 %), P = .001. In contrast, screening rates for esophageal varices were 75 % at the Faculty Practice and only 58 and 43 % at the VA and safety-net sites, respectively (P < .001). Liver transplant discussions were documented most consistently at the Faculty Practice (82 %) compared to the safety-net site (53 %) and VA (54 %), P < .001.



Disparities in cirrhosis quality measures existed by site. Strategies to overcome these disparities need to be developed to improve the delivery of quality cirrhosis care as we face a rise in cirrhosis-related complications over the next two decades.
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. ssclair@med.miami.edu.
Seth N
SN
Sclair
Division of General Internal Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.|Miami Clinical and Translational Sciences Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Olveen
O
Carrasquillo
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Frank
F
Czul
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Juan P
JP
Trivella
Miami Clinical and Translational Sciences Institute, University of Miami Miller School of Medicine, Miami, FL, USA.|Biostatistics Collaboration and Consulting Core, Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL, USA.
Hua
H
Li
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.|Hepatology Section, Medicine Service, Miami VA Medical Center, Miami, FL, USA.
Lennox
L
Jeffers
Division of Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Paul
P
Martin
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D015331:Cohort Studies; D003695:Delivery of Health Care; D019468:Disease Management; D055088:Early Detection of Cancer; D058625:End Stage Liver Disease; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005180:Faculty, Medical; D005260:Female; D000072102:Gastroenterologists; D005762:Gastroenterology / Q000592:standards*; D019983:Guideline Adherence; D006506:Hepatitis A / Q000517:prevention & control; D022362:Hepatitis A Vaccines / Q000627:therapeutic use; D006509:Hepatitis B / Q000517:prevention & control; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States; D014493:United States Department of Veterans Affairs
D022362:Hepatitis A Vaccines; D017325:Hepatitis B Vaccines
Chronic liver disease; Cirrhosis; Guideline adherence; Healthcare disparities; Physician quality reporting system; Quality indicators