Adherence to quality indicators and hospital outcomes for patients with decompensated cirrhosis: An observational study

Abstract

BACKGROUND: Quality indicators (QIs) exist for the care of patients with cirrhosis. We retrospectively examined the records of patients admitted to a large academic tertiary care centre for adherence to QIs and examined for an association between QI adherence and hospital outcomes. METHODS: We conducted a cross-sectional study of all patients with decompensated liver cirrhosis admitted to a large academic tertiary care centre over a 2-year period (2014–2016). Medical records of 522 patients were examined for 17 QIs related to inpatient cirrhosis care and adherence-judged using three different standards: 100% adherence, 70% adherence, or the QI score as a continuous variable. Linear and logistic regression was used to evaluate the association between QI score and length of stay (LOS), 30-day readmissions, and inpatient mortality, respectively. RESULTS: Adherence to QIs was variable (range 20%–95%). Overall, adherence to QIs relating to variceal bleeding was higher than adherence to indicators related to hepatic encephalopathy and spontaneous bacterial peritonitis. There was weak evidence for a decreased odds of 30-day readmission when more QIs were met, regardless of the method used to quantify adherence (100% standard OR 0.53 [95% CI 0.26–1.09, p = .09], 70% standard OR 0.58 [95% CI 0.32–1.06, p = .08], continuous method OR 0.90 [95% CI 0.81–1.01, p = .07]). There was no observed relationship between mortality and QI adherence and equivocal evidence for an association between QI adherence and LOS. CONCLUSIONS: Adherence to QIs related to inpatient care of decompensated cirrhosis may be associated with decreased 30-day readmissions