A Comparative Effectiveness Study on Impact of Subspecialty Care in Management of Cirrhotics with Upper Gastrointestinal Bleeding: 924

Introduction: Decompensated cirrhosis is a common cause of admissions and readmissions to the hospital, and the burden posed by cirrhosis is amplified by significant gaps in the quality of care delivered. Recent studies showed that proportions of quality indicators (QI) met for care of cirrhotic patients are strikingly low. Due to the complexity nature of liver diseases and its complications, we hypothesized that referral to subspecialty care may improve quality of care and outcomes in this group of patients. Our aims are: 1) to address whether Hepatology consultation influences the adherence to the QI measures in patients who are admitted for upper gastrointestinal bleeding 2) to determine if the cohort with access to Hepatology consultation has better outcome. Methods: Our study cohort comprised of adult cirrhotic patients with upper gastrointestinal bleeding who are admitted to a large academic transplant center between 7/1/2013 to 9/30/2015 and screened by admitting diagnoses. Using previously published quality indicators (QIs) by Kanwal et al., 2010, we compared the cohort who received care from any of the three hepatologist in our center, with regard to patient characteristics, QI measures receipt and clinical outcomes.Table 1: Adherence of quality indicators, defined as percentage of cirrhosis patients with UGIB who received the care (numerator) among those who are eligible of the indicator (denominator) in the two different care groups, with and without hepatology consultTable 2: Clinical outcomes in patients who receive hepatology consult and patients who did notResults: We identified 177 patients for inclusion, 72 (40.7%) patients were seen by hepatologist, 105 (59.3%) were not. The mean age for our cohort was 53.8-year old, 67% were male, mean MELD-Na on admission in cohort seen by hepatologist slightly higher than patients who are not seen by hepatologist (19.3 vs 18.4). Overall, the adherence of QIs measures was between 48.6% to 93.8%, and individual adherence rates are higher in group that was seen by hepatologist, shown in table 1. Clinical outcomes are presented in table 2, demonstrating higher cost in patients seen by hepatologist but similar length of stay in both groups. Number of readmissions after the initial encouter is lower in patients seen by hepatologist and patients are more likely to be seen at outpatient within 30-days of discharge in this cohort seen by hepatologist. Conclusion: These results suggest that Hepatology subspecialty care may improve adherence to QIs and clinical outcomes, although this results in higher cost incurred. We will use this data to further investigate other clinically significant outcomes over a longer duration to determine how prognosis is affected in this group of patients and derive a quality improvement project that will improve quality of care in patients with cirrhosis.