Hunt, Gregory Trimble Background: Patient outcomes are being increasingly tracked by government institutions and payors. As such, quality improvement initiatives have increasing importance in healthcare delivery. Prior groups have studied clinical outcomes in liver disease such as length of stay GSI-IX (LOS) or 30-day readmis-sion rates but not how to systematically decrease these indicators. Others have proposed quality guidelines but not how to implement or measure adherence to these standards. We launched a quality-improvement intervention to reduce length of stay and readmission rates for inpatients with cirrhosis. Methods: Prospective, pre-post design to assess
the impact of a care protocol on a dedicated liver unit in a teaching hospital with a liver transplant program from 2010 to 2013. 2010 was a control period. Our intervention was multiphasic. First in mid- 2011, the ‘checklist’ phase centered on a hand-held checklist to prompt 1) medication review (DVT prophylaxis, var-iceal bleeding prophylaxis, etc), 2) standardized treatment and prophylaxis of spontaneous bacterial peritonitis
(SBP) (specific dosing of antibiotics and albumin) and 3) aggressive, goal-directed Ivacaftor purchase therapy for acute encephalopathy (adjusting frequency of lactulose dosing to grade of encephalopathy) with universal rifaximin. Adherence was actively promoted and tracked by an observer. In the second (‘electronic’) phase, there was no observer or enforced medication review. We incorporated the other elements into the electronic ordering system. Outcomes included LOS, readmission and 90-day death rate. Results: 824 unique patients with cirrhosis were admitted 1720 times during the study period. They were aged 56.5 + 12.1 years with an average MELD Decitabine mw of 17.7 + 7.4 and median Charlson index of 4.0 (IQR 2-6). Median LOS was 4 (IQR 2-8), readmission rate was 32.9% and 90-day mortality was 18.9%, all consistent with national averages. The effect of each intervention
phase was adjusted for known confounders and detailed in table 1. No significant effect on 90-day mortality or length of stay was observed. 30-day readmissions were decreased sharply during the intervention period, particularly in the electronic phase. Conclusions: A quality improvement initiative can reduce 30-day readmission rates for patients with cirrhosis and hepatic encephalopathy. Disclosures: The following people have nothing to disclose: Elliot B. Tapper, Dan Finkelstein, Gail Piatkowski, Murray Mittleman, Michelle Lai Over 50% of hepatitis C cases are undetected . CDC and USPTF recommend screening the birth-cohort born between 1945 and 1965 which includes about 60% of all HCV cases.
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