ArticleThe American journal of gastroenterology2016
Access to Subspecialty Care And Survival Among Patients With Liver Disease.
Article in The American journal of gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- Portal hypertension mortality in the United States (1999-2023): Insights from the CDC WONDER database.Medicine · 2026Article
- Workforce Issues in Hepatology.Gastroenterology & hepatology · 2026Article
- Dental prophylactic interventions are associated with lower decompensation-related hospitalizations over 2 years in cirrhosis.JHEP reports : innovation in hepatology · 2026Article
- Cause-specific mortality among Queensland people with cirrhosis, by cirrhosis aetiology and decompensation status, 2007-22: a retrospective cohort study.The Medical journal of Australia · 2025Article
- Three-year of hepatocellular carcinoma surveillance in patients with cirrhosis diagnosed between 2009 and 2013: a cohort study based on the French National Health Data System (SNDS) claims data.Frontiers in oncology · 2025Article
- Prevalence of Healthcare Barriers Among US Adults With Chronic Liver Disease Compared to Other Chronic Diseases.Gastro hep advances · 2024Article
- Access to technology to support telehealth in areas without specialty care for liver disease.Hepatology (Baltimore, Md.) · 2023Article
- Patient Characteristics Associated with Access to Minimally Invasive Gynecologic Surgery: Changes during the COVID-19 Pandemic.Journal of minimally invasive gynecology · 2022Article
- Factors Associated with Survival of Hepatocellular Carcinoma (HCC) Patients at a Safety Net Hospital in Arizona without On-Site Liver Transplant Program.Journal of hepatocellular carcinoma · 2022Article
- Differences in Hospitalization Outcomes of Kidney Disease between Patients Who Received Care by Nephrologists and Non-Nephrologist Physicians: A Propensity-Score-Matched Study.Journal of clinical medicine · 2021Article
- Coordination of Care Is Associated With Survival and Health Care Utilization in a Population-Based Study of Patients With Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2020Article
- Outcomes after hepatic encephalopathy in population-based cohorts of patients with cirrhosis.Alimentary pharmacology & therapeutics · 2020Article
- The Quality and Outcomes of Care Provided to Patients with Cirrhosis by Advanced Practice Providers.Hepatology (Baltimore, Md.) · 2020Article
- Quality Measures, All-Cause Mortality, and Health Care Use in a National Cohort of Veterans With Cirrhosis.Hepatology (Baltimore, Md.) · 2019Article
- Incidence of and Risk Factors for Hepatic Encephalopathy in a Population-Based Cohort of Americans With Cirrhosis.Hepatology communications · 2019Article
- Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus: The Veteran Birth Cohort.Medical care · 2019Observational
- Screening and Treating Hepatitis C in the VA: Achieving Excellence Using Lean and System Redesign.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2018Article
- Differences in Referral Access to Care Between Gastrointestinal Subspecialty Patients: Barriers and Opportunities.Health equity · 2018Article
- Strategies to Reduce 30-Day Readmissions in Patients with Cirrhosis.Current gastroenterology reports · 2017Review
- Telemedicine Improves Access to Hepatology Consultation with High Patient Satisfaction.Journal of clinical and experimental hepatologyArticle
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
objectivesAccess to subspecialty care may be difficult for patients with liver disease, but it is unknown whether access influences outcomes among this population. Our objectives were to determine rates and predictors of access to ambulatory gastrointestinal (GI) subspecialty care for patients with liver disease and to determine whether access to subspecialty GI care is associated with better survival.
methodsWe studied 28,861 patients within the Veterans Administration VISN 11 Liver Disease cohort who had an ICD-9-CM diagnosis code for liver disease from 1 January 2000 through 30 May 2011. Access was defined as a completed outpatient clinic visit with a gastroenterologist or hepatologist at any time after diagnosis. Multivariable logistic regression was used to determine predictors of access to a GI subspecialist. Survival curves were compared between those who did and those who did not see a specialist, with propensity score adjustment to account for other covariates that may affect access.
resultsOverall, 10,710 patients (37%) had a completed GI visit. On multivariable regression, older patients (odds ratio (OR) 0.98, P<0.001), those with more comorbidities (OR 0.98, P=0.01), and those living farther from a tertiary-care center (OR 0.998/mi, P<0.001) were less likely to be seen in clinic. Patients who were more likely to be seen included those who had hepatitis C (OR 1.5, P<0.001) or cirrhosis (OR 3.5, P<0.001) diagnoses prior to their initial visit. Patients with an ambulatory GI visit at any time after diagnosis were less likely to die at 5 years when compared with propensity-score-matched controls (hazard ratio 0.81, P<0.001).
conclusionsAccess to ambulatory GI care was associated with improved 5-year survival for patients with liver disease. Innovative care coordination techniques may prove beneficial in extending access to care to liver disease patients.
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