Parker Richard, Allison Michael, Anderson Seonaid, Aspinall Richard, Bardell Sara, Bains Vikram, Buchanan Ryan, Corless Lynsey, Davidson Ian, Dundas Pauline, Fernandez Jeff, Forrest Ewan, Forster Erica, Freshwater Dennis, Gailer Ruth, Goldin Robert, Hebditch Vanessa, Hood Steve, Jones Arron, Lavers Victoria, Lindsay Deborah, Maurice James, McDonagh Joanne, Morgan Sarah, Nurun Tania, Oldroyd Christopher, Oxley Elizabeth, Pannifex Sally, Parsons Graham, Phillips Thomas, Rainford Nicole, Rajoriya Neil, Richardson Paul, Ryan J, Sayer Joanne, Smith Mandy, Srivastava Ankur, Stennett Emma, Towey Jennifer, Vaziri Roya, Webzell Ian, Wellstead Andrew, Dhanda Ashwin, Masson Steven
Leeds Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, UK.
BMJ Open Gastroenterol. 2023 Oct;10(1). doi: 10.1136/bmjgast-2023-001221.
Alcohol-related liver disease (ALD) is the most common cause of liver-related ill health and liver-related deaths in the UK, and deaths from ALD have doubled in the last decade. The management of ALD requires treatment of both liver disease and alcohol use; this necessitates effective and constructive multidisciplinary working. To support this, we have developed quality standard recommendations for the management of ALD, based on evidence and consensus expert opinion, with the aim of improving patient care.
A multidisciplinary group of experts from the British Association for the Study of the Liver and British Society of Gastroenterology ALD Special Interest Group developed the quality standards, with input from the British Liver Trust and patient representatives.
The standards cover three broad themes: the recognition and diagnosis of people with ALD in primary care and the liver outpatient clinic; the management of acutely decompensated ALD including acute alcohol-related hepatitis and the posthospital care of people with advanced liver disease due to ALD. Draft quality standards were initially developed by smaller working groups and then an anonymous modified Delphi voting process was conducted by the entire group to assess the level of agreement with each statement. Statements were included when agreement was 85% or greater. Twenty-four quality standards were produced from this process which support best practice. From the final list of statements, a smaller number of auditable key performance indicators were selected to allow services to benchmark their practice and an audit tool provided.
It is hoped that services will review their practice against these recommendations and key performance indicators and institute service development where needed to improve the care of patients with ALD.
酒精性肝病（ALD）是英国肝脏相关健康问题和肝脏相关死亡的最常见原因，且在过去十年中，ALD导致的死亡人数翻了一番。ALD的管理需要同时治疗肝脏疾病和酒精使用问题；这就需要有效且具建设性的多学科协作。为支持这一点，我们基于证据和专家共识意见，制定了ALD管理的质量标准建议，旨在改善患者护理。
来自英国肝脏研究协会和英国胃肠病学会ALD特别兴趣小组的多学科专家小组制定了这些质量标准，并得到了英国肝脏信托基金和患者代表的意见。
这些标准涵盖三个广泛主题：在初级保健和肝脏门诊对ALD患者的识别与诊断；急性失代偿性ALD的管理，包括急性酒精性肝炎以及ALD所致晚期肝病患者的出院后护理。质量标准草案最初由较小的工作组制定，然后整个小组进行了匿名的德尔菲投票修改流程，以评估对每条陈述的认同程度。当认同度达到85%或更高时，相关陈述被纳入。通过这一过程产生了24条支持最佳实践的质量标准。从最终陈述列表中，选取了数量较少的可审计关键绩效指标，以便各医疗机构以此为基准评估自身实践，并提供了一种审计工具。
希望各医疗机构对照这些建议和关键绩效指标审查自身实践，并在必要时开展服务改进，以改善ALD患者的护理。
