Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter?
Evaluation of liver test abnormalities in a patient-centered medical home: do liver test patterns matter?
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以患者为中心的医疗之家中肝脏测试异常的评估：肝脏测试模式重要吗？
DOI：
10.1136/jim-2018-000788
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Rockey,DonC
中科院分区：
文献类型：
--
作者：
Schreiner,AndrewD;Moran,WilliamP;Zhang,Jingwen;Kirkland,ElizabethB;Heincelman,MarcE;SchumannIii,SamuelO;Mauldin,PatrickD;Rockey,DonC
肝脏检查异常在临床实践中极为常见，表现出不同的模式和程度的升高，并且可能表明多种原因引起的肝损伤。应对这些异常需要复杂的医疗决策，并且需要在初级保健中进行调查。这项回顾性研究调查了肝脏检查异常模式与初级保健随访的关系。这项研究使用管理数据，纳入了 2007 年至 2016 年间在以患者为中心的医疗之家发现的肝脏检查异常的患者。检查的肝脏检查包括血清胆红素、天冬氨酸转氨酶、丙氨酸转氨酶和碱性磷酸酶。患者在第一次肝脏测试升高时进入队列。检查的结果是重复测试的完成情况，并通过指标异常模式比较未随访的患者比例。 9545 名患者符合纳入标准。其中，6155人（64.5%）的肝脏检查指标有一项异常，3390人（35.5%）的指标检查有多项异常。总共 1119 名 (11.7%) 患者在研究期间没有进行重复检测。与患有多种异常的患者相比，更大比例的患有单一异常的患者缺乏重复检测。在比较异常的临床模式时，重复测试出现了差异，测试提示胆汁淤积的患者的随访比例较高。超过11%的肝脏检查异常的患者在研究期间没有接受重复检查。重复检测更常见于具有多种异常和提示胆汁淤积临床模式的患者。这项研究强调了提高护理质量的潜在机会。
Abnormal liver tests are extremely common in clinical practice, present with varying patterns and degrees of elevation, and can signal liver injury from a variety of causes. Responding to these abnormalities requires complex medical decision-making and merits investigation in primary care. This retrospective study investigates the association of patterns of liver test abnormality with follow-up in primary care. Using administrative data, this study includes patients with abnormal liver tests seen between 2007 and 2016 in a patient-centered medical home. Liver tests examined include serum bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Patients entered the cohort on the first liver test elevation. The outcome examined was completion of repeat testing, and the proportions of patients without follow-up were compared by patterns of index abnormality. 9545 patients met the inclusion criteria. Of these, 6155 (64.5%) possessed one liver test abnormality and 3390 (35.5%) possessed multiple abnormalities on index testing. Overall 1119 (11.7%) patients did not have repeat testing performed during the study period. A greater proportion of patients with lone abnormalities lacked repeat testing compared with those patients with multiple abnormalities. Differences in repeat testing appeared when comparing clinical patterns of abnormality, with higher proportions of follow-up in patients with testing suggestive of cholestasis. Over 11% of patients with abnormal liver tests did not undergo repeat testing during the study period. Repeat testing occurred more often in patients with multiple abnormalities and in clinical patterns suggestive of cholestasis. This study highlights a potential opportunity to improve quality of care.
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影响因子：
3.6
作者：
Lilford, R. J.;Bentham, L.;Altman, D.
通讯作者：
Altman, D.
影响因子：
--
作者：
Sherwood, P;Lyburn, I;Ryder, S
通讯作者：
Ryder, S
影响因子：
2.9
作者：
Lilford RJ;Bentham LM;Armstrong MJ;Neuberger J;Girling AJ
通讯作者：
Girling AJ
影响因子：
6.1
作者：
Z. Younossi
通讯作者：
Z. Younossi
影响因子：
24.5
作者：
Newsome PN;Cramb R;Davison SM;Dillon JF;Foulerton M;Godfrey EM;Hall R;Harrower U;Hudson M;Langford A;Mackie A;Mitchell-Thain R;Sennett K;Sheron NC;Verne J;Walmsley M;Yeoman A
通讯作者：
Yeoman A