Smith Rachel, Burke Laura, Abbas Nadir, Aspinall Richard J, Thorburn Douglas, Heneghan Michael, Yeoman Andrew, Leithead Joanna, Braniff Conor, Mitchell-Thain Robert, Jones Rebecca L, McPherson Stuart, Dyson Jessica K, Jones David, Trivedi Palak J, Alrubaiy Laith, Mells George F
Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Hepatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
JHEP Rep. 2025 Apr 10;7(9):101422. doi: 10.1016/j.jhepr.2025.101422. eCollection 2025 Sep.
BACKGROUND & AIMS: In 2021, we conducted a UK-wide audit of the management of primary biliary cholangitis (PBC) in the National Health Service (NHS) of the UK, which identified widespread deficiencies in PBC-related healthcare. In the current study, recognising the need to address these deficiencies, we aimed to (1) develop a PBC care bundle to support clinicians in the provision of high-quality, standardised care; (2) pilot the bundle in selected centres across the UK; and (3) re-evaluate adherence to quality standards.
We designed a PBC care bundle that incorporated a checklist of quality standards and a summary of guidelines from the British Society of Gastroenterology. Twelve hospitals, with variable performance in the national audit, were invited to pilot the bundle between 1 October 2023 and 31 March 2024. Clinical data were collected to compare adherence to quality standards before and after bundle use.
We obtained data about 773 patients with PBC. We found significant improvement in performance across all quality standards following bundle use, with two hospitals achieving target performance (≥90%) across all standards, something not achieved by any hospital in the national audit. Across all centres, referral of patients for second-line therapy increased from 72% to 94% ( <0.001). Assessment of symptoms improved from 54% to 90% ( <0.001), and bone health improved from 65% to 86% ( <0.001). Surveillance for hepatocellular carcinoma increased from 67% to 97% ( <0.001), and screening for gastro-oesophageal varices improved from 81% to 92% ( = 0.027).
Use of the PBC care bundle significantly improves adherence to management guidelines. Rollout of the bundle will mark a vital step to improve the delivery of high-quality care to all patients with PBC.
The national primary biliary cholangitis (PBC) audit demonstrated critical shortfalls in the delivery of PBC-related healthcare across the UK. In this study, we have designed a PBC care bundle to improve adherence to management guidelines and promote standardised care. We show that use of the bundle improves care delivery in hospitals across the NHS. The PBC care bundle has been endorsed by the British Society of Gastroenterology and the British Association for the Study of the Liver and is freely available online to all clinicians to support the provision of high-quality PBC-related healthcare.
2021年，我们在英国国家医疗服务体系（NHS）开展了一项全英国范围的原发性胆汁性胆管炎（PBC）管理审计，发现PBC相关医疗保健存在广泛缺陷。在本研究中，认识到有必要解决这些缺陷，我们旨在：（1）制定一个PBC护理包，以支持临床医生提供高质量、标准化的护理；（2）在英国各地选定的中心对该护理包进行试点；（3）重新评估对质量标准的遵守情况。
我们设计了一个PBC护理包，其中包含质量标准清单和英国胃肠病学会指南摘要。邀请了12家在全国审计中表现各异的医院在2023年10月1日至2024年3月31日期间对该护理包进行试点。收集临床数据以比较使用护理包前后对质量标准的遵守情况。
我们获得了773例PBC患者的数据。我们发现使用护理包后所有质量标准的表现都有显著改善，两家医院在所有标准上都达到了目标表现（≥90%），这是全国审计中任何医院都未实现的。在所有中心，转诊接受二线治疗的患者比例从72%增至94%（<0.001）。症状评估从54%改善至90%（<0.001），骨骼健康从65%改善至86%（<0.001）。肝细胞癌监测从67%增至97%（<0.001），胃食管静脉曲张筛查从81%改善至92%（=0.027）。
使用PBC护理包显著提高了对管理指南的遵守情况。推广该护理包将是朝着为所有PBC患者提供高质量护理迈出的关键一步。
全国原发性胆汁性胆管炎（PBC）审计表明，英国各地在提供PBC相关医疗保健方面存在严重不足。在本研究中，我们设计了一个PBC护理包，以提高对管理指南的遵守情况并促进标准化护理。我们表明，使用该护理包可改善NHS各医院的护理服务。PBC护理包已得到英国胃肠病学会和英国肝脏研究协会的认可，所有临床医生均可在网上免费获取，以支持提供高质量的PBC相关医疗保健。
