Background/Aims

We examined the quality of palliative care received by patients with decompensated cirrhosis using an explicit set of palliative care quality indicators (QIs) for patients with end-stage liver disease (PC-ESLD).

Methods

We identified patients newly diagnosed with decompensated cirrhosis at a single veterans health center and followed up them for 2 years or until death. We piloted measurement of PC-ESLD QIs in all patients confirmed to have ESLD using a chart abstraction tool.

Results

Out of 167 patients identified using at least one sampling strategy, 62 were confirmed to meet ESLD criteria with chart abstraction. Ninety-eight percent of veterans in the cohort were male, mean age at diagnosis was 61 years, and 74% were White. The overall QI pass rate was 68% (64% for information care planning QIs and 76% for supportive care QIs). Patients receiving specialty palliative care consultation were more likely to receive information care planning QIs (67% vs. 37%, p = 0.02). The best performing sampling strategy had a sensitivity of 62% and specificity of 60%.

Conclusion

Measuring the quality of palliative care for patients with ESLD is feasible in the veteran population. Our single-center data suggest that the quality of palliative care is inadequate in the veteran population with ESLD, though patients offered specialty palliative care consultation and those affected by homelessness, drug, and alcohol abuse may receive better care. Our combination of ICD-9 codes can be used to identify a cohort of patients with ESLD, though better sensitivity and specificity may be needed.

中文翻译：

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衡量终末期肝病患者姑息治疗的质量。

背景/目标

我们使用一套明确的终末期肝病 (PC-ESLD) 患者姑息治疗质量指标 (QI) 来检查失代偿期肝硬化患者接受的姑息治疗质量。

方法

我们在一个退伍军人健康中心确定了新诊断为失代偿期肝硬化的患者，并对他们进行了 2 年的随访或直至死亡。我们使用图表抽象工具对所有确认患有 ESLD 的患者进行了 PC-ESLD QIs 的试点测量。

结果

在使用至少一种抽样策略确定的 167 名患者中，62 名通过图表抽象确认符合 ESLD 标准。该队列中 98% 的退伍军人为男性，诊断时的平均年龄为 61 岁，74% 为白人。整体 QI 合格率为 68%（信息护理计划 QI 为 64%，支持性护理 QI 为 76%）。接受专业姑息治疗咨询的患者更有可能接受信息护理计划 QI（67% 对 37%，p  = 0.02）。表现最佳的抽样策略的敏感性为 62%，特异性为 60%。

结论

衡量 ESLD 患者姑息治疗的质量在退伍军人中是可行的。我们的单中心数据表明，在患有 ESLD 的退伍军人中，姑息治疗的质量不足，尽管患者提供了专业的姑息治疗咨询，而那些受到无家可归、吸毒和酗酒影响的人可能会得到更好的护理。我们的 ICD-9 代码组合可用于识别 ESLD 患者队列，但可能需要更好的敏感性和特异性。