住院主治医生专业和胃肠病学咨询对肝硬化失代偿患者的护理质量的影响。
Impact of Inpatient Attending Specialty and Gastroenterology Consultation on Quality of Care of Patients Hospitalized with Decompensated Cirrhosis.
机构信息
Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor.
出版信息
Am J Med. 2021 Oct;134(10):1270-1277.e2. doi: 10.1016/j.amjmed.2021.05.010. Epub 2021 Jun 16.
BACKGROUND
Data suggest hospitalists are less adherent to quality indicators for decompensated cirrhosis, and gastroenterology consultation may improve adherence. We sought to evaluate the impact of inpatient attending specialty and gastroenterology consultation on quality of care for decompensated cirrhosis.
METHODS
This was a retrospective cohort study of patients with decompensated cirrhosis admitted to gastroenterology or hospitalist service at the University of Michigan between 2016-2020. The primary outcome was adherence to nationally recommended inpatient quality indicators for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and gastrointestinal bleeding. Performance was calculated per patient admission as the proportion of quality indicators met vs quality indicators for which the patient was eligible. Quality indicator scores were compared between services using t-tests. We also evaluated the effect of gastroenterology consultation on quality indicator scores for patients admitted to hospitalist service. Clinical outcomes were compared using multivariable models adjusted for patient characteristics.
RESULTS
Two hundred eighty-eight admissions were included (155 to gastroenterology service; 133 to hospitalist service). Quality indicator score for all admissions was 69.9% (standard deviation [SD] ± 24.2%). Quality indicator scores were similar between gastroenterology (69.9%, SD ± 23.6%) and hospitalist (69.8%, SD ± 25.1%) services (P = .913). There was no difference in quality indicator subscores for each complication between services. Hospitalists placed a gastroenterology consultation in 53.4% of admissions, and it was associated with higher albumin administration for patients with spontaneous bacterial peritonitis (57.1% vs 25%, P = .044). Patients admitted to gastroenterology service had higher readmissions within 30 days (adjusted odds ratio = 1.95) and shorter length of hospitalization (adjusted rate ratio = 0.85).
CONCLUSIONS
Hospitalists provided comparable quality of care to gastroenterologists for inpatients with decompensated cirrhosis.
背景
数据表明，医院医师对失代偿性肝硬化的质量指标的遵循程度较低，而胃肠病学咨询可能会提高遵循程度。我们旨在评估住院主治医生的专业类别和胃肠病学咨询对失代偿性肝硬化患者护理质量的影响。
方法
这是一项回顾性队列研究，纳入了 2016 年至 2020 年间在密歇根大学接受胃肠病学或医院医师服务治疗的失代偿性肝硬化患者。主要结局是评估符合全国推荐的腹水、肝性脑病、自发性细菌性腹膜炎和胃肠道出血的住院患者质量指标的遵循程度。每个患者入院时的表现均按符合的质量指标与符合条件的质量指标的比例计算。使用 t 检验比较两种服务的质量指标得分。我们还评估了胃肠病学咨询对医院医师服务入院患者质量指标得分的影响。使用多变量模型调整患者特征后比较临床结局。
结果
共纳入 288 例入院患者（155 例至胃肠病学服务；133 例至医院医师服务）。所有入院患者的质量指标评分为 69.9%（标准差[SD]±24.2%）。胃肠病学（69.9%，SD±23.6%）和医院医师（69.8%，SD±25.1%）服务的质量指标评分无差异（P=0.913）。两种服务的每种并发症的质量指标亚评分也无差异。医院医师在 53.4%的入院患者中进行了胃肠病学咨询，这与自发性细菌性腹膜炎患者白蛋白使用率的提高相关（57.1%比 25%，P=0.044）。接受胃肠病学服务的患者在 30 天内的再入院率更高（调整后优势比=1.95），住院时间更短（调整后速率比=0.85）。
结论
医院医师为失代偿性肝硬化住院患者提供的护理质量与胃肠病学家相当。
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