Lim Nicholas, Sanchez Otto, Olson Andrew
Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, United States.
Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN 55455, United States.
World J Hepatol. 2019 Oct 27;11(10):701-709. doi: 10.4254/wjh.v11.i10.701.
A low proportion of patients admitted to hospital with cirrhosis receive quality care with timely paracentesis an important target for improvement. We hypothesized that a medical educational intervention, delivered to medical residents caring for patients with cirrhosis, would improve quality of care.
To determine if an educational intervention can improve quality of care in cirrhotic patients admitted to hospital with ascites.
We performed a pilot prospective cohort study with time-based randomization over six months at a large teaching hospital. Residents rotating on hospital medicine teams received an educational intervention while residents rotating on hospital medicine teams on alternate months comprised the control group. The primary outcome was provision of quality care- defined as adherence to all quality-based indicators derived from evidence-based practice guidelines- in admissions for patients with cirrhosis and ascites. Patient clinical outcomes- including length of hospital stay (LOS); 30-d readmission; in-hospital mortality and overall mortality- and resident educational outcomes were also evaluated.
Eighty-five admissions (60 unique patients) met inclusion criteria over the study period-46 admissions in the intervention group and 39 admissions in the control group. Thirty-seven admissions were female patients, and 44 admissions were for alcoholic liver disease. Mean model for end-stage liver disease (MELD)-Na score at admission was 25.8. Forty-seven (55.3%) admissions received quality care. There was no difference in the provision of quality care (56.41% 54.35%, 0.9) between the two groups. 30-d readmission was lower in the intervention group (35% 52.78%, 0.1) and after correction for age, gender and MELD-Na score [RR = 0.62 (0.39, 1.00), 0.05]. No significant differences were seen for LOS, complications, in-hospital mortality or overall mortality between the two groups. Resident medical knowledge and self-efficacy with paracentesis improved after the educational intervention.
Medical education has the potential to improve clinical outcomes in patients admitted to hospital with cirrhosis and ascites.
肝硬化住院患者中接受优质护理的比例较低，及时进行腹腔穿刺是一个重要的改进目标。我们假设，对照顾肝硬化患者的住院医师实施医学教育干预可提高护理质量。
确定教育干预能否改善因腹水入院的肝硬化患者的护理质量。
我们在一家大型教学医院进行了一项为期六个月的前瞻性队列试验，并按时间进行随机分组。在医院内科团队轮转的住院医师接受教育干预，而每隔一个月在医院内科团队轮转的住院医师作为对照组。主要结局是为肝硬化腹水患者入院时提供优质护理，优质护理定义为遵守基于循证实践指南的所有质量指标。还评估了患者的临床结局，包括住院时间（LOS）、30天再入院率、院内死亡率和总死亡率，以及住院医师的教育结局。
在研究期间，85例入院患者（60例不同患者）符合纳入标准，干预组46例入院，对照组39例入院。37例入院患者为女性，44例入院患者为酒精性肝病。入院时终末期肝病模型（MELD）-Na评分的平均值为25.8。47例（55.3%）入院患者接受了优质护理。两组之间在优质护理的提供方面无差异（56.41%对54.35%；P=0.9）。干预组的30天再入院率较低（35%对52.78%；P=0.1），在对年龄、性别和MELD-Na评分进行校正后[相对危险度（RR）=0.62（0.39，1.00）；P=0.05]。两组之间在住院时间、并发症、院内死亡率或总死亡率方面未观察到显著差异。教育干预后，住院医师关于腹腔穿刺的医学知识和自我效能得到改善。
医学教育有可能改善因肝硬化和腹水入院患者的临床结局。
