Access to Subspecialty Care And Survival Among Patients With Liver Disease.
Access to Subspecialty Care And Survival Among Patients With Liver Disease.
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DOI：
10.1038/ajg.2016.96
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Su GL
中科院分区：
文献类型：
--
作者：
Mellinger JL;Moser S;Welsh DE;Yosef MT;Van T;McCurdy H;Rakoski MO;Moseley RH;Glass L;Waljee AK;Volk ML;Sales A;Su GL
对于肝病患者来说，获得亚专科护理可能很困难，但尚不清楚获得亚专科护理是否会影响该人群的结果。我们的目标是确定肝病患者获得门诊胃肠道 (GI) 亚专科护理的比率和预测因素，并确定获得胃肠道亚专科护理是否与更好的生存相关。我们研究了退伍军人管理局 VISN 11 肝病队列中的 28,861 名患者，这些患者在 2000 年 1 月 1 日至 2011 年 5 月 30 日期间具有 ICD-9-CM 肝病诊断代码。访问的定义是诊断后随时接受胃肠病学家或肝病学家的完整门诊就诊。使用多变量逻辑回归来确定获得胃肠道专科医生的预测因素。比较了那些去看专科医生和那些没有去看专科医生的人的生存曲线，并进行倾向评分调整以考虑可能影响访问的其他协变量。总体而言，10,710 名患者 (37%) 完成了胃肠道就诊。在多变量回归中，老年患者（比值比 (OR) 0.98，P<0.001）、合并症较多的患者（OR 0.98，P=0.01）和居住距离三级护理中心较远的患者（OR 0.998/mi，P<0.001）在临床就诊的可能性较小。更有可能就诊的患者包括在初次就诊之前诊断出丙型肝炎（OR 1.5，P<0.001）或肝硬化（OR 3.5，P<0.001）的患者。与倾向评分匹配的对照组相比，诊断后任何时间进行胃肠道门诊就诊的患者 5 年后死亡的可能性较小（风险比 0.81，P<0.001）。获得门诊胃肠道护理与肝病患者 5 年生存率的提高相关。创新的护理协调技术可能有助于扩大肝病患者获得护理的机会。
Access to subspecialty care may be difficult for patients with liver disease, but it is unknown whether access influences outcomes among this population. Our objectives were to determine rates and predictors of access to ambulatory gastrointestinal (GI) subspecialty care for patients with liver disease and to determine whether access to subspecialty GI care is associated with better survival. We studied 28,861 patients within the Veterans Administration VISN 11 Liver Disease cohort who had an ICD-9-CM diagnosis code for liver disease from 1 January 2000 through 30 May 2011. Access was defined as a completed outpatient clinic visit with a gastroenterologist or hepatologist at any time after diagnosis. Multivariable logistic regression was used to determine predictors of access to a GI subspecialist. Survival curves were compared between those who did and those who did not see a specialist, with propensity score adjustment to account for other covariates that may affect access. Overall, 10,710 patients (37%) had a completed GI visit. On multivariable regression, older patients (odds ratio (OR) 0.98, P<0.001), those with more comorbidities (OR 0.98, P=0.01), and those living farther from a tertiary-care center (OR 0.998/mi, P<0.001) were less likely to be seen in clinic. Patients who were more likely to be seen included those who had hepatitis C (OR 1.5, P<0.001) or cirrhosis (OR 3.5, P<0.001) diagnoses prior to their initial visit. Patients with an ambulatory GI visit at any time after diagnosis were less likely to die at 5 years when compared with propensity-score-matched controls (hazard ratio 0.81, P<0.001). Access to ambulatory GI care was associated with improved 5-year survival for patients with liver disease. Innovative care coordination techniques may prove beneficial in extending access to care to liver disease patients.
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影响因子：
12.6
作者：
Mellinger, Jessica L.;Volk, Michael L.
通讯作者：
Volk, Michael L.
影响因子：
13.5
作者：
Bini, EJ;Weinshel, EH;Komorowski, T
通讯作者：
Komorowski, T
影响因子：
13.5
作者：
Dominitz, JA;Boyko, EJ;Sporleder, JL
通讯作者：
Sporleder, JL
DOI：
10.7326/0003-4819-127-8_part_2-199710151-00064
发表时间：
1997-10-15
影响因子：
39.2
作者：
Rubin, DB
通讯作者：
Rubin, DB
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN