SAN DIEGO — Public hospitals can adhere more closely to practice guidelines for patients with cirrhosis than faculty practices, according to data presented at the 2012 Digestive Disease Week Annual Meeting.
In a retrospective chart review, researchers evaluated data from 153 patients with cirrhosis, including 74 who were treated at a faculty practice (FP) and 79 who were treated at a public hospital (PH) by faculty-supervised trainees between Oct. 1, 2010 and March 31, 2011. Participants across both groups were similar in demographics, cirrhosis etiology and the number of visits. The purpose of the study was to determine how adherence to AASLD practice guidelines related to the site at which care was administered.
PH patients were found more likely to have met vaccination guidelines than FP patients (81% vs. 46% for hepatitis A; 76% vs. 29% for hepatitis B, P<.01 for both) and also were more likely to have undergone annual screenings for hepatocellular carcinoma through imaging and serum AFP (90% vs. 70%, P<.01). FP patients were more likely to have undergone screening via endoscopy for gastroephageal varices (97% vs. 87%, P<.05), and more FP patients had a primary screening within the first 6 months of care (71% vs. 43%, P<.01). PH patients were less likely to have discussed liver transplant with their provider (53% vs. 81%, P<.01), and also were less likely to be referred for transplant evaluation (20% vs. 42%, P<.01).
“Patients with cirrhosis have a lot of needs, and even at a specialty clinic there are areas where we can still improve, in terms of anticipating complications of cirrhosis,” researcher Seth N. Sclair, MD, told Healio.com. “It’s challenging to get all these things done, and there are a lot of reasons we’re not able to … but more attention needs to be paid to it.” He added that researchers have since collected additional data from a third cohort of patients at a VA hospital, and a subsequent study will compare the three sites with the eventual goal of implementing patient-based intervention to improve guideline adherence and level the quality of care.
For more information:
Sclair SN. #Su1045: Disparities in the Application of Practice Guidelines in Patients With Cirrhosis Reflect Site of Care. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, San Diego.