Munsakul Natt, Chalermsuksant Nalerdon, Sethasine Supatsri
Division of Gastroenterology and Hepatology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University. 681 Samsen Road, Dusit District 10300, Bangkok, Thailand.
Asian Pac J Cancer Prev. 2024 Dec 1;25(12):4153-4159. doi: 10.31557/APJCP.2024.25.12.4153.
BACKGROUND/AIMS: Variations in cirrhosis management practices and care quality affect patient prognoses and outcomes. We aimed to evaluate the number of successful cirrhosis care processes and the relationship between the quality statement implementation and clinical outcomes in patients with cirrhosis.
This retrospective cohort study included hospitalized patients with cirrhosis. Eighteen process-based methods were independently assessed. Measurement indices for each participant were selected per cirrhosis severity. Service quality was determined using standard settings for each process-based gap scale. The optimal care group comprised participants who adhered to all instruction quality indices. Kaplan-Meier survival analysis assessed the 90-day readmission and mortality rates relating to the optimal quality care.
Of the 205 patients (73.2% male; mean age, 62.7±11.8 years), the median Model for End-stage Liver Disease score was 15.35 (9.37-21.37), and the majority were Child-Pugh B/C. Previously set performance gaps were observed for 13/18 quality processes, and 5/13 clinical processes attained the final goal. Paracentesis in ascites patients, antibiotic administration within 12 hours of spontaneous bacterial peritonitis diagnosis, and precipitating factors identification with lactulose therapy were the top three quality index (QI) accomplishments. Out of 205 patients, 84 attained optimal care. Concerning optimal care, although the readmission rate remained same, patients with decompensated Child-Pugh C who received excellent complete QI care had significantly increased both 1-month (100% vs. 43.5%; p=0.022) and 3-month (100% vs. 26.1%; p=0.022) survival in comparison to those receiving incomplete QI care.
Using quality metrics for the appropriate stage of individual cirrhosis treatment is advocated as best practice. Adherence to standard practices improves clinical outcomes.
背景/目的：肝硬化管理实践和护理质量的差异会影响患者的预后和结局。我们旨在评估肝硬化护理流程的成功数量以及肝硬化患者质量声明实施与临床结局之间的关系。
这项回顾性队列研究纳入了住院的肝硬化患者。对18种基于流程的方法进行了独立评估。根据肝硬化严重程度为每位参与者选择测量指标。使用每个基于流程的差距量表的标准设置来确定服务质量。最佳护理组包括遵守所有指令质量指标的参与者。Kaplan-Meier生存分析评估了与最佳质量护理相关的90天再入院率和死亡率。
在205例患者中（男性占73.2%；平均年龄62.7±11.8岁），终末期肝病模型评分中位数为15.35（9.37 - 21.37），大多数为Child-Pugh B/C级。在18个质量流程中有13个观察到先前设定的绩效差距，13个临床流程中有5个达到了最终目标。腹水患者的腹腔穿刺术、自发性细菌性腹膜炎诊断后12小时内给予抗生素以及用乳果糖治疗识别诱发因素是前三项质量指标成就。在205例患者中，84例获得了最佳护理。关于最佳护理，尽管再入院率保持不变，但与接受不完全质量指标护理的患者相比，接受优质完整质量指标护理的失代偿性Child-Pugh C级患者1个月（100%对43.5%；p = 0.022）和3个月（100%对26.1%；p = 0.022）生存率均显著提高。
提倡将质量指标用于个体肝硬化治疗的适当阶段作为最佳实践。坚持标准做法可改善临床结局。
