1 Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.
2 Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
4 Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA.
5 Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
6 VA Puget Sound Health Care System, Health Services Research and Development, Seattle, WA.
7 VA Puget Sound Health Care System, General Medicine Service, Seattle, WA, USA.
8 Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
9 VA Connecticut Healthcare System, West Haven, Connecticut, CT.
10 Division of Gastroenterology, Yale University School of Medicine, New Haven, CT.
11 Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Decompensated cirrhosis is associated with high morbidity and mortality. However, no standardized quality measures (QMs) have yet been adopted widely. The Veterans Affairs (VA) Advanced Liver Disease Technical Advisory Group recently developed a set of six internal QMs to guide quality improvement efforts in cirrhosis in the domains of access to care, hepatocellular carcinomasurveillance, variceal surveillance, quality of inpatient care for upper gastrointestinal (GI) bleeding, and cirrhosis-related rehospitalizations. We aimed to: 1) quantify adherence to cirrhosis QMs and 2) determine whether adherence was associated with all-cause mortality and health-care utilization within a large national cohort of Veterans with cirrhosis. We performed a retrospective study using data from the Veterans Outcomes and Costs Asociated with Liver Disease cohort of 121,129 patients newly diagnosed with cirrhosis from 1/1/2008 to 12/31/16 at 128 VA facilities. The mean follow-up time was 2.7 years (interquartile range 1.1-5.1 years). Adherence to outpatient access to specialty care was 71%, variceal surveillance was 32%, and early post-discharge care was 54%. In adjusted analyses, outpatient access to specialty care (hazard ratio [HR] 0.80; 95% confidence interval [CI]: 0.78-0.82), hepatocellular carcinoma surveillance (HR 0.92, 95% CI: 0.90-0.95), variceal surveillance (HR 0.93; 95% CI: 0.89-0.99), and early post-discharge care (HR 0.57; 95% CI: 0.54-0.60) were associated with lower all-cause mortality. Readmissions after 30 days (HR 1.53; 1.46-1.60) and 90-days (HR 1.88; 95% CI: 1.54-1.70) were associated higher all-cause mortality. Higher adherence to QMs was also associated with lower inpatient healthcare utilization. CONCLUSIONS: Five of the six proposed VA cirrhosis QMs were measurable using existing data sources, associated with mortality and healthcare utilization, and may be used to guide future quality improvement efforts in cirrhosis. This