A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis.
A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis.
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DOI：
10.1016/j.cgh.2015.08.041
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Lai M
中科院分区：
文献类型：
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作者：
Tapper EB;Finkelstein D;Mittleman MA;Piatkowski G;Chang M;Lai M
30-day readmissions for hospitalized patients with cirrhosis are common, particularly for patients with hepatic encephalopathy (HE). We performed a prospective pre-post study from 2010–2013 to assess the impact of a quality improvement (QI) protocol on 30-day readmissions to a transplant center’s liver unit. The intervention included a yearlong control period, a handheld checklist and an “electronic” phase incorporating checklist items into the electronic provider order entry system. The intervention included goal-directed lactulose therapy and universal rifaximin for overt HE as well as prompts for antibiotic prophylaxis of spontaneous bacterial peritonitis (SBP). 30-day readmission trends were compared to non-cirrhotic patients admitted to hospitalists and patients with decompensated cirrhosis at another center. 824 patients were admitted 1720 times. The average model for end-stage liver disease score on admission was 17.7 ± 7.4. The electronic phase was associated with 40% lower adjusted odds of 30-day readmission compared to control, both overall and for patients with HE. The proportion of admissions for ≥ grade 2 HE that resulted in a readmission fell from 48.9% (66/135) in the control period to 26.0% (27/104) in the electronic phase (p = 0.0003). Rifaximin use for HE and antibiotic secondary prophylaxis of SBP (on discharge) were associated with lower adjusted odds of readmission (respective OR 0.39 and 0.40). The electronic phase was associated with a lower length of stay (beta coefficient −1.34 95% CI: −2.38 – −0.32, p = 0.01). A QI initiative using electronic decision support reduced 30-day readmissions for patients with cirrhosis.
