ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2016
A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 5 of them syntheses that pooled it.
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Who cites it
69 citing papers in PubMed, 5 syntheses or guidelines pooled it, 152 citations in OpenAlex.
- CROATIAN GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF PORTAL HYPERTENSION.Acta clinica Croatica · 2024Guideline
- Rifaximin for prevention and treatment of hepatic encephalopathy in people with cirrhosis.The Cochrane database of systematic reviews · 2023Pooled it
- Quality Improvement in Gastroenterology: A Systematic Review of Practical Interventions for Clinicians.Digestive diseases and sciences · 2018Pooled it
- Systematic Review of the Economic Burden of Overt Hepatic Encephalopathy and Pharmacoeconomic Impact of Rifaximin.PharmacoEconomics · 2018Pooled it
- Diagnosis of Minimal Hepatic Encephalopathy: A Systematic Review of Point-of-Care Diagnostic Tests.The American journal of gastroenterology · 2018Pooled it
- Randomized intervention and outpatient follow-up lowers 30-d readmissions for patients with hepatic encephalopathy, decompensated cirrhosis.World journal of hepatology · 2023Trial
- Using machine learning methods to predict 28-day mortality in patients with hepatic encephalopathy.BMC gastroenterology · 2023Trial
- Aetiology and outcomes of emergency admissions for chronic liver disease in England, 2012-2019: a national cohort study using administrative data.BMJ open gastroenterology · 2026Article
- Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review.Journal of clinical and translational hepatology · 2026Review
- Predictors of 30-Day Readmission in Patients With Cirrhosis: A Retrospective Cohort Study.Cureus · 2026Article
- Clinical outcomes and care for spontaneous bacterial peritonitis: A national cohort study.Hepatology (Baltimore, Md.) · 2025Article
- Clinical impact of Choosing Wisely Canada hepatology recommendations: an interrupted time-series analysis using data from GEMINI.BMJ open quality · 2025Article
- Electronic Interventions to Improve Quality for Inpatient Cirrhosis Care: A Prospective Evaluation.The American journal of gastroenterology · 2025Article
- Hepatic encephalopathy and spontaneous bacterial peritonitis are associated with increased liver-related readmissions in cirrhosis.Frontiers in medicine · 2025Article
- Modulation of brain energy metabolism in hepatic encephalopathy: impact of glucose metabolic dysfunction.Metabolic brain disease · 2024Review
- Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities, and Outcomes.The American journal of gastroenterology · 2024Article
- Novel, nurse-led early postdischarge clinic is associated with fewer readmissions and lower mortality following hospitalisation with decompensated cirrhosis.Frontline gastroenterology · 2024Article
- Hepatic Encephalopathy among Patients with Chronic Liver Disease Admitted to the Department of Internal Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study.JNMA; journal of the Nepal Medical Association · 2023Article
- Implementing a cirrhosis order set in a tertiary healthcare system: a theory-informed formative evaluation.BMC health services research · 2023Article
- Confusion assessment method accurately screens for hepatic encephalopathy and predicts short-term mortality in hospitalized patients with cirrhosis.Metabolic brain disease · 2023Article
9 more citing papers are in PubMed but not listed here.
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsMany hospitalized patients with cirrhosis are readmitted to the hospital within 30 days, particularly those with hepatic encephalopathy (HE). We performed a prospective study to assess the effects of a quality improvement protocol on readmission to a transplant center's liver unit within 30 days.
methodsWe studied the effects of a quality improvement program in 824 unique patients with decompensated cirrhosis or receiving liver transplants (mean Model for End-Stage Liver Disease score, 17.7 ± 7.4) admitted to an inpatient hepatology unit from 2010 through 2013. The study had a year-long control period (626 admissions receiving usual care) and 2 intervention phases: a hand-held checklist phase (470 admissions) and an electronic phase that incorporated the checklist items into the electronic provider order entry system (624 admissions). The intervention phases included goal-directed lactulose therapy and rifaximin for overt HE, and prompts for antibiotic prophylaxis of spontaneous bacterial peritonitis. The primary endpoint was the difference in 30-day readmissions between the control and intervention phases. Trends in 30-day readmissions were compared with those of patients with decompensated cirrhosis admitted at another center.
resultsDuring the electronic phase, study subjects had 40% lower adjusted odds of 30-day readmission than during the control period. The slope of the decline in readmissions over time was significantly greater than for patients at the other center (P < .0001). The proportion of patients with greater than grade 2 HE and 30-day readmission was 48.9% (66 of 135) in the control period versus 26.0% (27 of 104) in the electronic phase (P = .0003). Treatment of HE with rifaximin and secondary prophylaxis of spontaneous bacterial peritonitis with antibiotics (on discharge) were associated with lower adjusted odds of readmission (odds ratios, 0.39 and 0.40, respectively). The electronic phase was associated with 1.34 fewer hospital days for HE compared with the control period (P = .01).
conclusionsIn a prospective study, a quality improvement initiative that included electronic decision support reduced readmissions of patients with cirrhosis to the hospital within 30 days.
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Registered trials
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