P2993 - Targeting Quality Measures in Cirrhosis: A Guidelines-Based Initiative to Improve Inpatient Cirrhosis Management

Indira Bhavsar-Burke, MD¹, Nour Hamade, MD¹, Steven Gerke, MD¹, Sean Burke, MD¹, Katherine Merrill, RN², Daniel Seitz, MD², Karalea Mulvey, PharmD², Eric Orman, MD¹, Nabil Fayad, MD^1
1Indiana University School of Medicine, Indianapolis, IN; ²Eskenazi Medical Group, Indianapolis, IN

Introduction: Recent practice guidance from the American Association for the Study of Liver Diseases defines both process and outcome measures for the inpatient management of cirrhosis patients. These quality metrics are critical for improving outcomes for cirrhosis patients. We aimed to evaluate current adherence to these recommendations and create a novel tool in the electronic health record (EHR) to improve performance.

Methods: This study was performed at the safety-net county teaching hospital in Indianapolis which is affiliated with the Indiana University School of Medicine. Retrospective chart review of patients with cirrhosis admitted between October 19, 2020 and November 29, 2020 was performed to establish baseline rates of adherence to practice guidance. A cirrhosis order set, created and edited by a multidisciplinary team, was piloted for content from November 30, 2021 to January 31, 2021. At the end of the pilot period, a retrospective review of patient encounters was conducted to assess usage of the order set and its impact on adherence rates to practice guidelines using an independent samples t-test. We also performed a multivariate analysis to establish factors associated with a diagnosis of cirrhosis to identify patients who may benefit from usage of the order set.

Results: Baseline performance of 202 encounters indicated that diagnostic paracentesis, low sodium diet, and social work involvement were appropriately used in 27.2%, 48.2%, and 42.1% of encounters, respectively. The order set was used in 5% of qualifying encounters during the pilot period and did not have a significant impact in improving adherence rates to guidelines (p = .440). Multivariate analysis of pilot encounters indicates that Total Bilirubin [OR 1.31 (0.93, 1.89), p = .044], Serum Sodium [OR 5.19 (3.88, 7.10), p = .003], INR [OR 3.47 (2.79, 4.11), p = .031], and Platelets [OR 6.27 (4.32, 14.65), p = .001] were independently associated with a diagnosis of cirrhosis.

Discussion: Our study highlights the need for interventions to improve physician compliance with performance measures. The availability of an order set alone did not significantly change rates of adherence. Based on the findings from the multivariate analysis, we were able to create a novel alert system in the EHR that can immediately direct providers to the order set when certain laboratory parameters are met. Further study on the use of the order set with the built-in alert is currently underway.


Disclosures:


Indira Bhavsar-Burke, MD¹, Nour Hamade, MD¹, Steven Gerke, MD¹, Sean Burke, MD¹, Katherine Merrill, RN², Daniel Seitz, MD², Karalea Mulvey, PharmD², Eric Orman, MD¹, Nabil Fayad, MD¹. P2993 - Targeting Quality Measures in Cirrhosis: A Guidelines-Based Initiative to Improve Inpatient Cirrhosis Management, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.