Table 2.
Percent Quality Indicators Met, per Admission, by Indication
| Condition (denominator) | Quality Indicator (numerator) | UC (n=379) | MC (n=316) | ||
|---|---|---|---|---|---|
| I. Admissions with Ascites | Met/Indicated* | Met/Indicated* | P value** | ||
| 1 | Admissions to the hospital because of ascites or encephalopathy | Diagnostic paracentesis during admission | 77/193 39.9% (32.9%, 46.9%) |
111/135 82.2% (75.7%, 88.8%) |
<0.001 |
| 2 | No fibrinolysis or disseminated. Intravascular coagulation before paracentesis INR < 2.5 >100,000 platelets |
No Fresh frozen plasma or platelet replacement given | 36/37 97.3% (91.8%, 103.0%) |
41/42 97.6% (92.8%, 102.4%) |
1.00 |
| 3 | All Admissions with diagnostic paracentesis (not limited to admissions for ascites or hepatic encephalopathy) | Cell count differential, total protein, albumin, & culture/sensitivity all performed. | 31/49 63.3% (49.3%–77.3%) |
46/72 63.9% (52.7%, 75.0%) |
1.00 |
| 4 | Admissions with known portal hypertension-related ascites receiving a paracentesis | Ascitic fluid cell count and differential performed | 15/104 14.4% (7.6%–21.3%) |
47/62 75.8% (63.2%, 88.4%) |
<0.001 |
| 5 | Serum sodium ≤ 110 mEq/L | Fluid Restriction and discontinuation of diuretics | NA | NA | NA |
| 6 | Polymorphonuclear count of ≥250/mm3 in ascites | Empiric antibiotics ≤6 hours of results | 10/13 76.9% (50.4%–103.4%) |
16/20 80.0% (60.8%, 99.2%) |
1.00 |
| 7 | Ascitic fluid total protein ≤1.1 gm/dL Serum bilirubin ≥2.5 mg/dL |
Prophylactic antibiotics | 4/12 33.3% (2.0%–64.6%) |
18/30 60.0% (41.4%, 78.6%) |
0.18 |
| 8 | Normal renal function | Salt restriction and diuretics (spironolactone & loop diuretics) | 57/186 30.6% (24.0%–37.3%) |
81/122 66.4% (57.9%, 74.9%) |
<0.001 |
| Total Ascites Subscore (Mean/Standard deviation SD) | 30%/36% | 67%/34% | <0.001 | ||
| II. GI bleeding | |||||
| 9 | Admissions with GI Bleeding: variceal and non variceal, hematemesis and melena |
Upper endoscopy ≤24 hours of presentation | 60/78 76.9% (67.4%, 86.4%) |
52/57 91.2% (83.7%, 98.8%) |
0.04 |
| 10 | Esophageal varices (active,stigmata of recent bleeding or no other causes to explain bleeding) | Endoscopic variceal ligation/sclerotherapy | 40/46 87.0% (76.8%–97.1%) |
30/32 93.8% (84.9%, 100.0%) |
0.46 |
| 11 | Admissions with established/suspected upper GI Bleeding | Antibiotics within 24 hours of admission | 27/69 39.1% (27.3%–50.9%) |
26/58 44.8% (31.6%, 58.0%) |
0.59 |
| 12 | Admissions with established/suspected variceal bleeding | Somatostatin/Octreotide given within 12 hours of presentation | 53/69 76.8% (66.6%–87.0%) |
49/58 84.5% (73.8%, 95.2%) |
0.37 |
| 13 | Recurrent bleeding within 72 hours of initial endoscopic hemostasis | Repeat endoscopy or transjugular intrahepatic portosystemic shunt | 5/5 100% |
2/3 66.7% (−76.8%, 210.0%) |
0.38 |
| Total GI Subscore (Mean/SD) | 61%/38% | 74%/28% | 0.04 | ||
| III. Liver Transplantation | |||||
| 14 | Admissions with MELD ≥15 ≪OR≫ MELD ≤15 and decompensated status i.e. all admissions in our study | Documented evaluation for liver transplantation | 112/379 29.6% (24.9%–34.2%) |
231/316 73.6% (68.7%, 78.5%) |
<0.001 |
| IV. Hepatic Encephalopathy | |||||
| 15 | Admissions with Hepatic Encephalopathy | Search for reversible factors documented | 81/151 53.6% (45.6%–61.7 %) |
97/113 85.8% (79.4%, 92.3%) |
<0.001 |
| 16 | Admissions with Hepatic Encephalopathy | Oral disaccharides/ rifaximin | 144/151 95.3% (91.9 %–98.7 %) |
107/113 94.7% (90.7%. 98.69%) |
1.00 |
| Total Encephalopathy Subscore (Mean/SD) | 75%/28% | 90%/24% | <0.001 | ||