Am J Med. 2021 Jun 15:S0002-9343(21)00366-1. doi: 10.1016/j.amjmed.2021.05.010. Online ahead of print.
BACKGROUND: Data suggest hospitalists are less adherent to quality indicators for decompensated cirrhosis and gastroenterology consultation may improve adherence. We sought to evaluate the impact of inpatient attending specialty and gastroenterology consultation on quality of care for decompensated cirrhosis.
METHODS: Retrospective cohort study of patients with decompensated cirrhosis admitted to gastroenterology or hospitalist service at University of Michigan between 2016-2020. Primary outcome was adherence to inpatient nationally recommended quality indicators for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and gastrointestinal bleeding. Performance was calculated per patient admission as proportion of quality indicators met versus quality indicators for which patient was eligible. Quality indicator scores were compared between services using t-tests. We also evaluated the effect of gastroenterology consultation on quality indicator scores for patients admitted to hospitalist service. Clinical outcomes were compared using multivariable models adjusted for patient characteristics.
RESULTS: 288 admissions were included (155 gastroenterology service; 133 hospitalist service). Quality indicator score for all admissions was 69.9% (SD ±24.2%). Quality indicator scores were similar between gastroenterology (69.9%, SD ±23.6%) and hospitalist (69.8%, SD ±25.1%) services (P 0.913). There was no difference in quality indicator subscores for each complication between services. Hospitalists placed a gastroenterology consultation in 53.4% of admissions and it was associated with higher albumin administration for patients with spontaneous bacterial peritonitis (57.1% vs. 25%, P 0.044). Patients admitted to gastroenterology service had higher readmissions within 30-days (aOR=1.95) and shorter length of hospitalization (aRR=0.85).
CONCLUSION: Hospitalists provided comparable quality of care to gastroenterologists for inpatients with decompensated cirrhosis.