ArticleHepatology (Baltimore, Md.)2020
The Quality and Outcomes of Care Provided to Patients with Cirrhosis by Advanced Practice Providers.
Article in Hepatology (Baltimore, Md.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed.
- Health-related quality of life in patients with liver cirrhosis following adjunctive nurse-based care versus standard medical care: a pragmatic, multicentre, randomised controlled study.BMJ open gastroenterology · 2025Trial
- Steatotic liver disease trajectory: A holistic EASL guidance on the multidisciplinary approach to screening and patient management.JHEP reports : innovation in hepatology · 2026Review
- Barriers to Medical Care Are Frequently Reported by Patients With Cirrhosis.Alimentary pharmacology & therapeutics · 2026Article
- Association of Cirrhosis Etiology With Outcomes after Transjugular Intrahepatic Portosystemic Shunt: A National Cohort Study.Gastro hep advances · 2026Article
- Acute Kidney Injury in Patients With Cirrhosis and Chronic Kidney Disease: Results From the HRS-HARMONY Consortium.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025Article
- How to improve the care of decompensated cirrhosis: the intervention model for chronic disease management.Hepatobiliary surgery and nutrition · 2025Article
- Do transition to practice hour requirements make a difference in adverse action and medical malpractice payment reports: An analysis from the National Practitioner Data Bank.Journal of the American Association of Nurse Practitioners · 2025Article
- Healthcare Contact Days Before and After Liver Transplant in Patients With Cirrhosis: A National Cohort Study.Clinical and translational gastroenterology · 2025Article
- Emergency Department Utilization and Outcomes Among Adults With Cirrhosis From 2008 to 2022 in the United States.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025Article
- Systems of care that improve outcomes for people with hepatic encephalopathy.Metabolic brain disease · 2024Review
- Patient perceived quality of cirrhosis care- adjunctive nurse-based care versus standard medical care: a pragmatic multicentre randomised controlled study.BMC nursing · 2024Article
- Association of Renin-Angiotensin System Inhibition With Liver-Related Events and Mortality in Compensated Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- The Scope of Practice for Primary Cardiovascular Disease Prevention Expanded to Advanced Practice Providers: What Does the Data Show?Current cardiology reports · 2023Review
- Exploring provider roles, continuity, and mental models in cirrhosis care: A qualitative study.Canadian liver journal · 2023Article
- Holistic management of hepatocellular carcinoma: The hepatologist's comprehensive playbook.Liver international : official journal of the International Association for the Study of the Liver · 2022Review
- Review article: current and emerging therapies for the management of cirrhosis and its complications.Alimentary pharmacology & therapeutics · 2022Review
- Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease.The American journal of medicine · 2022Article
- Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022Article
- Comparison of Seven Noninvasive Models for Predicting Decompensation and Hospitalization in Patients with Cirrhosis.Digestive diseases and sciences · 2021Article
- Quality of life as a therapeutic objective in the management of hepatic encephalopathy and the potential role of rifaximin-α.European journal of gastroenterology & hepatology · 2021Article
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Authors and funding
7 authors.
Funding
Abstract
Cirrhosis is morbid and increasingly prevalent, yet the U.S. health care system lacks enough physicians and specialists to adequately manage patients with cirrhosis. Although advanced practice providers (APPs) can expand access to cirrhosis-related care, their impact on the quality of care remains unknown. We sought to determine the effect on care quality and outcomes for patients managed by APPs using a retrospective analysis of a nationally representative American commercial claims database (Optum), which included 389,257 unique adults with cirrhosis. We evaluated a complication of process measures (i.e., rates of hepatocellular carcinoma [HCC] screening, endoscopic varices screening, and use of rifaximin after hospitalization for hepatic encephalopathy) and outcomes (30-day readmissions and survival). Compared with patients without APP care, patients with APP care had higher rates of HCC screening (adjusted odds ratio [OR] 1.23, 95% confidence interval 1.19, 1.27), varices screening (OR 1.20 [1.13, 1.27]), use of rifaximin after a discharge for hepatic encephalopathy (OR 2.09 [1.80, 2.43]), and reduced risk of 30-day readmission (OR 0.68 [0.66, 0.70]). Gastroenterology/hepatology consultation was also associated with improved quality metric performance compared with primary care; however, shared visits between gastroenterologists/hepatologists and APPs were associated with the best performance and lower 30-day readmissions compared with subspecialty consultation without an APP (OR 0.91 [0.87, 0.95]. Multivariate analysis adjusting for comorbidities, liver disease severity, and other factors including gastroenterology/hepatology consultation showed that patients seen by APPs were more likely to receive consistent HCC and varices screening over time, less likely to experience 30-day readmissions, and had lower mortality (adjusted hazard ratio 0.57, 95% confidence interval 0.55, 0.60). Conclusion: APPs, particularly when working with gastroenterologists/hepatologists, are associated with improved quality of care and outcomes for patients with cirrhosis.
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