Desai Archita P, Satoskar Rohit, Appannagari Anoop, Reddy K Gautham, Te Helen S, Reau Nancy, Meltzer David O, Jensen Donald
*Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine §Section of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, Department of Medicine ∥Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL †Georgetown University Medical Center, Georgetown Transplant Institute, Washington, DC ‡Section of Hospital Medicine, North Shore University Health System, Evanston, IL.
J Clin Gastroenterol. 2014 Apr;48(4):e30-6. doi: 10.1097/MCG.0b013e3182a87f70.
Our institution shifted the care of patients with chronic liver disease (CLD) from Internal Medicine faculty, house staff, and consulting hepatology service to a co-managed unit staffed by academic hospitalists and hepatologists. The effect of co-management between hospitalists and hepatologists on the care of patients hospitalized with complications of CLD such as spontaneous bacterial peritonitis (SBP) is unknown.
A retrospective chart review of 56 adult patients admitted with CLD and SBP from July 1, 2004 to June 30, 2010 was performed. Adherence rates to current management guidelines were measured along with costs and outcomes of care.
Patients admitted under the 2 models of care were similar; however, they consistently underwent paracentesis within 24 hours (100% vs. 79%, P=0.013), had appropriate avoidance of fresh-frozen plasma use (75% vs. 43%, P=0.05), received albumin (97% vs. 65%, P=0.002), and were discharged on SBP prophylaxis (91% vs. 37%, P<0.001) under the co-managed model compared with the conventional model. Costs of care were similar between the 2 groups. We note a trend toward improved outcomes of care under the co-management model as measured by transfer rates to the intensive care unit, inpatient mortality, 30-day readmission, and mortality rates.
These results support co-management between hospitalists and hepatologists as a superior model of care for hospitalized patients with SBP. Furthermore, this study adds to the growing literature indicating that efforts are needed to improve the quality of care delivered to CLD patients.
我们机构将慢性肝病（CLD）患者的护理工作，从内科教员、住院医师和肝病咨询服务部门，转移至由学术医院医师和肝病专家共同管理的科室。医院医师和肝病专家共同管理对因CLD并发症（如自发性细菌性腹膜炎，SBP）住院患者护理的影响尚不清楚。
对2004年7月1日至2010年6月30日期间收治的56例CLD合并SBP的成年患者进行回顾性病历审查。测量当前管理指南的依从率以及护理成本和结果。
在两种护理模式下入院的患者相似；然而，与传统模式相比，在共同管理模式下，患者在24小时内进行腹腔穿刺的比例更高（100%对79%，P=0.013），适当避免使用新鲜冰冻血浆（75%对43%，P=0.05），接受白蛋白治疗的比例更高（97%对65%，P=0.002），并且出院时接受SBP预防治疗的比例更高（91%对37%，P<0.001）。两组的护理成本相似。我们注意到，以转入重症监护病房的比例、住院死亡率、30天再入院率和死亡率衡量，共同管理模式下护理结果有改善的趋势。
这些结果支持医院医师和肝病专家共同管理，作为SBP住院患者的一种更优护理模式。此外，这项研究进一步补充了越来越多的文献，表明需要努力提高为CLD患者提供的护理质量。
