Fasiha Kanwal1,2,3, Elliot B Tapper4, Chanda Ho5, Sumeet K Asrani6, Nadia Ovchinsky7, John Poterucha8, Avegail Flores9, Victor Ankoma-Sey10, Bruce Luxon11, Michael Volk12. 1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX. 2. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. 3. Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX. 4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI. 5. Department of Transplantation, California Pacific Medical Center, San Francisco, CA. 6. Division of Hepatology, Baylor University Medical Center, Dallas, TX. 7. Division of Pediatric Gastroenterology, Children's Hospital at Montefiore, Bronx, NY. 8. Division of Gastroenterology, Mayo Clinic, Rochester, MN. 9. Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO. 10. Sherri & Alan Conover Center for Liver Disease & Transplantation, Department of Gastroenterology & Hepatology, Houston Methodist Hospital, Houston, TX. 11. Department of Medicine, Georgetown University, Washington, DC. 12. Division of Gastroenterology and Transplantation Institute, Loma Linda University, Loma Linda, CA.
Abstract
Health care delivery is increasingly evaluated according to quality measures, yet such measures are underdeveloped for cirrhosis. The Practice Metrics Committee of the American Association for the Study of Liver Diseases was charged with developing explicit process-based and outcome-based measures for adults with cirrhosis. We identified candidate measures from comprehensive reviews of the literature and input from expert clinicians and patient focus groups. We conducted an 11-member expert clinician panel and used a modified Delphi method to systematically identify a set of quality measures in cirrhosis. Among 119 candidate measures, 46 were identified as important measures to define the quality of cirrhosis care, including 26 process measures, 7 clinical outcome measures, and 13 patient-reported outcome measures. The final process measures captured care processes for ascites (n = 5), varices/bleeding (n = 7), hepatic encephalopathy (n = 4), hepatocellular cancer (HCC) screening (n = 1), liver transplantation evaluation (n = 2), and other care (n = 7). Clinical outcome measures included survival, variceal bleeding and rebleeding, early-stage HCC, liver-related hospitalization, and rehospitalization within 7 and 30 days. Patient-reported outcome measures covered physical symptoms, physical function, mental health, general function, cognition, social life, and satisfaction with care. The final list of patient-reported outcomes was validated in 79 patients with cirrhosis from nine institutions in the United States. Conclusion: We developed an explicit set of evidence-based quality measures for adult patients with cirrhosis. These measures are a tool for providers and institutions to evaluate their care quality, drive quality improvement, and deliver high-value cirrhosis care. The quality measures are intended to be applicable in any clinical care setting in which care for patients with cirrhosis is provided.
Health care delivery is increasingly evaluated according to quality measures, yet such measures are underdeveloped for cirrhosis. The Practice Metrics Committee of the American Association for the Study of Liver Diseases was charged with developing explicit process-based and outcome-based measures for adults with cirrhosis. We identified candidate measures from comprehensive reviews of the literature and input from expert clinicians and patient focus groups. We conducted an 11-member expert clinician panel and used a modified Delphi method to systematically identify a set of quality measures in cirrhosis. Among 119 candidate measures, 46 were identified as important measures to define the quality of cirrhosis care, including 26 process measures, 7 clinical outcome measures, and 13 patient-reported outcome measures. The final process measures captured care processes for ascites (n = 5), varices/bleeding (n = 7), hepatic encephalopathy (n = 4), hepatocellular cancer (HCC) screening (n = 1), liver transplantation evaluation (n = 2), and other care (n = 7). Clinical outcome measures included survival, variceal bleeding and rebleeding, early-stage HCC, liver-related hospitalization, and rehospitalization within 7 and 30 days. Patient-reported outcome measures covered physical symptoms, physical function, mental health, general function, cognition, social life, and satisfaction with care. The final list of patient-reported outcomes was validated in 79 patients with cirrhosis from nine institutions in the United States. Conclusion: We developed an explicit set of evidence-based quality measures for adult patients with cirrhosis. These measures are a tool for providers and institutions to evaluate their care quality, drive quality improvement, and deliver high-value cirrhosis care. The quality measures are intended to be applicable in any clinical care setting in which care for patients with cirrhosis is provided.
Authors: Gene Y Im; Jessica L Mellinger; Adam Winters; Elizabeth S Aby; Zurabi Lominadze; John Rice; Michael R Lucey; Juan P Arab; Aparna Goel; Loretta L Jophlin; Courtney B Sherman; Richard Parker; Po-Hung Chen; Deepika Devuni; Sandeep Sidhu; Winston Dunn; Gyongyi Szabo; Ashwani K Singal; Vijay H Shah Journal: Clin Gastroenterol Hepatol Date: 2020-10-16 Impact factor: 11.382
Authors: Marina Serper; David E Kaplan; Justine Shults; Peter P Reese; Lauren A Beste; Tamar H Taddei; Rachel M Werner Journal: Hepatology Date: 2019-06-26 Impact factor: 17.425
Authors: Jasmohan S Bajaj; Jacqueline G O'Leary; Puneeta Tandon; Florence Wong; Patrick S Kamath; Scott W Biggins; Guadalupe Garcia-Tsao; Jennifer Lai; Michael B Fallon; Paul J Thuluvath; Hugo E Vargas; Benedict Maliakkal; Ram M Subramanian; Leroy R Thacker; K Rajender Reddy Journal: Aliment Pharmacol Ther Date: 2019-04-29 Impact factor: 8.171
Authors: Lissi Hansen; Michael F Chang; Shirin Hiatt; Nathan F Dieckmann; Karen S Lyons; Christopher S Lee Journal: Dig Dis Sci Date: 2021-08-27 Impact factor: 3.487
Authors: Amit G Singal; Anna S Lok; Ziding Feng; Fasiha Kanwal; Neehar D Parikh Journal: Clin Gastroenterol Hepatol Date: 2020-09-19 Impact factor: 11.382
Authors: Jessica L Mellinger; Gerald Scott Winder; Anne C Fernandez; Kristin Klevering; Amanda Johnson; Haila Asefah; Mary Figueroa; Jack Buchanan; Fred Blow; Anna S F Lok Journal: J Subst Abuse Treat Date: 2021-04-09