- Email: [email protected]
Mo1041 Patients Readmitted Post-Hospitalization for Complications of Cirrhosis
adjusting for potential confounders, blacks had a significantly higher mortality during HCCrelated admissions (OR 1.43, 95% CI 1.04-1.98) compared to whites. This difference was highest in admissions not associated with therapeutic procedures (OR 1.57, 95% CI 1.142.15). Similarly, Asians/Pacific Islanders also had increased overall inpatient mortality in HCC-related admissions (OR 1.61, 95% CI 1.13-2.29), particularly for non-procedure related admissions (OR 1.64, 95% CI 1.11-2.41) compared to whites. Interestingly there was increased mortality among Hispanics in procedure-related admissions compared to whites (OR 3.00, 95% CI 1.03-8.74) but not for non-procedure related admissions. Conclusion: Significant racial disparities exist in outcomes of HCC-related hospitalizations. Black patients have lower frequency of therapeutic-procedures associated with hospitalizations and significantly greater in-hospital mortality. Further studies are required to determine reasons behind such disparities in order to improve outcomes. Table 1: Proportion of procedure related and non-procedure related hepatocellular carcinoma admissions by race
IV, RR 1.6 CI 1.5-1.8 and stage V, RR 1.6 CI 1.4-1.8), being underweight (RR 1.3 CI 1.11.4), and being a smoker within 1 year of surgery (RR 1.1 CI 1.0-1.2). Diabetes and cardiovascular disease were not significantly associated with mortality. For every 0.1-point increase in serum albumin, there was a 2.7% (p<0.001) decrease in the mortality risk. For every 0.1-point increase in the INR, there was a 1.5% (p<0.001) increase in mortality risk. Type of surgery (cardiac, thoracic, orthopedic, vascular or open abdominal) was not a significant predictor of mortality on multivariate analysis. Laparoscopic surgery did carry a 44% risk reduction when compared to non-laparoscopic surgery types. Conclusion: We found that models used to predict mortality risk would likely benefit from consistently including age, nutritional status, smoking status and renal dysfunction all of which predict short-term surgical mortality. Laparoscopic approach should be considered whenever possible. Lack of association with surgery type, diabetes and cardiac disease may reflect appropriate pre-operative selection biases balancing these variables with surgical need. Mo1040
AASLD Abstracts
Predictors of Early Readmission in Patients Hospitalized With Cirrhosis Neil R. Volk, Zilla H. Hussain, Spencer L. James, Andree H. Koop, Swapna Sharma, Kerry Guyer, Rolland Dickson Background: The management of cirrhosis in the US is estimated to result in an annual cost of $9,576 to $22,424 per affected person. Hospital readmissions within a month of discharge are estimated to occur in 37% of patients, contributing significantly to cost and representing a potential area for improvement. Our aim was to identify factors that predict early readmission and to highlight those that may be modifiable. Methods: The study was a retrospective review of all patients admitted with a primary diagnosis of cirrhosis from 4/ 1/2011 to 12/31/2012 at a single tertiary care institution. Time to readmission, frequency of readmission, medications at time of discharge, length to primary care (PCP) follow up, length to gastroenterology (GI) follow up and lab values at time of discharge were examined. Odds ratios were calculated using univariate logistic regressions and are presented in Table 1. Results: 317 unique patients had a total of 498 admissions during the study period. The mean number of admissions per patient was 2.4, the average number of days to the next readmission was 88 days. The average age was 57.9 years, 58% were male. During the study period 11% of patients died during a hospital admission. The average length of stay was 7.3 days with an average cost per admission of $43,874. The percent readmitted within 30 days of the index admission was 8.3% and 15.6% within 60 days. Patients admitted on the index admission with hepatic encephalopathy were more likely to have readmissions (OR 3.12, p=0.008), while those admitted for a non-cirrhotic related cause were less likely to be readmitted (OR 0.56, p=0.005). A history of hepatocellular carcinoma was strongly linked with a risk for readmission (OR 7.25, p= 0.009), while etiology of underlying liver disease did not significantly affect the risk of readmission. There was no significant effect on readmission rates within 60 days of discharge by MELD score, laboratory tests, or medications prescribed. Follow up within 30 days either with primary care or Gastroenterology was associated with an increased odds of readmission (OR 1.5, p=0.02). Conclusion: Readmission of cirrhotic patients during a recent time interval was less frequent than previously reported. Admission for encephalopathy and HCC were associated with high risk of readmission and represent areas where more intensive outpatient intervention needs to be explored. Follow up within 30 days was associated with increased risk of readmission. Scheduled follow up earlier (within 7 days) could potentially allow intervention which could decrease readmission rates. This is currently being investigated at our institution. Association between primary diagnosis at admission and 60 day readmission in patients with Cirrhosis
Table 2: Results of multivariate analysis of HCC related admission
Adjusted for age, sex, insurance, income quartile, Elixhauser comorbidity burden, and hospital characteristics. The outcome of inpatient mortality was also adjusted for HCCrelated procedure. Mo1039 Surgical Mortality in Patients With Cirrhosis: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program, 20052012 Monica L. Schmidt, Paul H. Hayashi, Alfred S. Barritt
Table 1 Mo1041
Background: In the U.S., liver cirrhosis is expected to affect more than 1 million individuals by 2020. Like the general population, cirrhosis patients will have an increasing elderly demographic with more comorbidities. Traditional surgical risk scores that do not include age and comorbidities may not adequately reflect operative risk in these patients. We sought to define operative mortality risk factors among patients with cirrhosis looking specifically at age and comorbidities. Methods: This study used the American College of Surgeons National Surgical Quality Improvement Program data (NSQIP) from years 2005-2012. Data are collected through electronic medical records. 2,297,189 surgical cases were collected between 2005-2012. To identify patients with cirrhosis, first, all patients with an esophageal hemorrhage or ascites as identified by NSQIP were extracted. Second, patients with platelets <140, albumin<3.2 and INR>1.5 were subset from those with ascites or hemorrhage. Patients with cancer were excluded. Using a Poisson regression model with robust standard errors and 30-day mortality as our primary outcome, relative risk was reported for selected preoperative variables including pre-operative laboratory results, patient age, surgery type and comorbidities. Results: The diagnostic algorithm identified 23,731 patients with cirrhosis. Mean age was 58 years in 2005 and increased to 63 years by 2012. 52.8 % were male. 85.9% were Caucasian. Among patients with cirrhosis, factors that increase risk of postsurgical mortality for any surgery type were increasing age (2.1% increase in risk per year increase in age, CI 1.8-2.4), chronic kidney disease stage (stage III, RR 1.5 CI 1.3-1.6; stage
AASLD Abstracts
Patients Readmitted Post-Hospitalization for Complications of Cirrhosis Siamak M. Seraj, Emily J. Campbell, Sarah A. Keegan, James M. Richter Background and Aims-Currently, 30-day readmission post-hospitalization is both a quality of care metric and a fiscal goal, as such re-hospitalizations are costly and may result in financial penalties for health centers. Our institution has sought to improve the continuity of care for high-risk patients through post-discharge phone calls, as well as care management programs for chronic conditions such as heart disease and diabetes. We aim to extend such programs to patients with cirrhosis to improve clinical outcomes and reduce readmissions. We therefore sought to describe such patients and define the predictors of 30-day readmission in an inpatient cohort. Methods- We performed a retrospective study of 560 inpatient admissions for chronic liver disease in 2012 at a tertiary referral medical center. Of those, we studied 123 unique patients who were hospitalized due to complications of cirrhosis (245 admissions). Exclusion criteria included status post-transplant, advanced CHF or ESRD, and patients not followed at our center or who died after the index hospitalization. Univariate and Multivariate analyses were performed to describe variables associated with 30-day readmission. Results- Our patient cohort is described in Table 1. A total of 43 patients (35%) were readmitted at any time in 2012. Twenty-two (17%) patients had at least one readmission due to complications of cirrhosis within 30 days, while 40 (32%) were ultimately
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by 7% (30 days) and 17% (60 days). Imaging for HCC remained above 90% at 30 days and improved by 4% to 100% at 60 days. Pneumovax compliance improved by 17% (30 days) and 51% (60 days). Influenza vaccination was unchanged (30 days) and improved by 8% (60 days). Hepatitis A vaccination improved by 11% (30 days) and by 30% (60 days). Hepatitis B vaccination remained unchanged (30 days) and improved by 23% (60 days). Documenting hepatitis A serology improved by 18% (30 days) and sustained at this rate at 60 days. Hepatitis B serology improved by 37% (30 days) and 43 % (60 days). Discussion: Based on preliminary results periodic ‘cumulative provider performance feedback' is a simple and effective method to improve and maintain adherence to quality measures for cirrhosis. Long term maintenance of this intervention will be measured by assessing the data at 6 months and one year from baseline distribution of data. We are also creating a CPRS-based physician reminder system to document and assure further QI compliance.
AASLD Abstracts
readmitted within 90 days of discharge. The most common cause of 30-day readmission was hepatic encephalopathy (32%) followed by GI bleeding (18%), spontaneous bacterial peritonitis (18%) and volume overload (14%). Nearly half of these readmitted patients (46%) were hospitalized with the same index-admission complication. Thirty six percent (36%) and 27% of readmitted patients had ethanol and NASH/cryptogenic-related cirrhosis respectively. Mean MELD at admission and discharge were 16 and 14, respectively, for patients with at least one 30-day readmission. Logistic regression analysis showed hepatic encephalopathy at index as the only significant independent predictor of 30-day readmission (OR 6.89, 95% CI 2.11 - 22.5). Length of stay, discharge day of the week, marital status, education level, mental health status and etiology of liver disease were not significant predictors of readmission. Conclusion- Hepatologists are responsible for directing the continuous care and management of patients with liver disease. The measurement of readmissions therefore becomes an important metric of care for these patients. We found a 30-day readmission rate of 17% at our center, while 32% were readmitted within 90 days, with hepatic encephalopathy at index as the significant predictor for 30-day readmission. Through continued systematic study and intervention, we may be able to improve care for these costly and high-risk patients. Select characteristics of study cohort
Mo1043 A Natural Language Processing Alogrithm for Identification of Patients With Cirrhosis From Electronic Medical Records Robert Kung, Ariel Ma, John B. Dever, Jaya Vadivelu, Erika Cherk, Jejo D. Koola, Erik J. Groessl, Michael E. Matheny, Samuel B. Ho Objectives: The numbers of patients with cirrhosis is increasing and they are considered high risk/ high cost patients. Few patients receive liver biopsies for diagnosis and noninvasive methods of identifying cirrhotic patients are needed. Informatics technology, such as natural language processing (NLP) and statistical text mining (STM) can extract unstructured data from the electronic medical record which may improve upon the accuracy of current non-invasive markers of cirrhosis. The aim of this study was to test the sensitivity and specificity of a NLP algorithm for extraction of text data from an electronic medical record for identification of patients with cirrhosis. Methods: To test a NLP clinical alogrithm tool, we identified 270 consecutive patients who underwent liver biopsy from 2009-2012. Variables associated with presence or development of cirrhosis that were available prior to the biopsy were manually collected from radiology reports (cirrhosis assertion, liver contour, ascites, varices, splenomegaly), clinic notes (mention of cirrhosis, physical exam findings, ICD-9 based problem lists, and psychosocial risk factors, alcohol/substance abuse, marginal housing/homelessness, psychiatric disorder). Diagnostic accuracy was compared to commonly used non-invasive markers of cirrhosis APRI >1.5 and FIB4>3.25 and to liver biopsy. Results: Of 270 patients, 96% were male, and indications for liver biopsy included hepatitis C (70%), hepatitis B (10%), and nonalcoholic fatty liver disease (8%). 44/270 (16%) of the cohort had biopsy proven cirrhosis. The sensitivity and specificity of the factors used are indicated in the Table. Radiological findings associated with cirrhosis were present in 54% of cirrhotics overall. Physical exam findings indicative of cirrhosis were present in 10/44 (23%). Problem lists included cirrhosis in 24/44 (54%). High risk psychosocial factors occurred in 32/44 (73%). Compared with APRI alone, the use of APRI and/or Radiology findings increased sensitivity to 75% with specificity to 85%. The addition of NLP exam and note factors increased sensitivity to 75% with specificity to 80%. The use of problem lists or psychosocial factors did provide additional sensitivity; Conclusions: This natural language processing algorithm has the potential to increase the sensitivity identification of patients with cirrhosis in the EMR compared to commonly used non-invasive markers, primarily with application of radiology related factors. Further development of a NLP tool will be needed for identification and risk stratification of patients with cirrhosis from large patient populations.
Mo1042 Assessment of Adherence to Baseline Quality Measures for Cirrhosis and Impact of 'Performance Feedback' in a Regional VA Medical Center Jennifer Cahill, Syed Rizvi, Kia Saeian Background: Task forces on quality improvement appointed by various gastroenterology societies have published comprehensive guidelines to help better manage patients with cirrhosis. Data is scant on extent to which gastroenterologists and hepatologists adhere to recommended guidelines. Limited published data suggests suboptimal compliance with these quality indicators. Hence, there is a need to create a method to improve the adherence to quality improvement (QI) measures. Our aim is to assess baseline adherence to QI measures, develop a system to improve adherence by sending periodic provider performance feedback and measure the impact of feedback on QI over time. Methods: Using VA VINCI database, patients with diagnosis of cirrhosis seen in GI clinic at VA Medical Center between 2006 to 2012 were identified. Deceased patients or those seen only once in GI clinic were excluded. To assess baseline compliance with QI, ICD-9 and CPT codes were used to develop 6-year retrospective registry database. Charts were then reviewed for documentation of hepatitis A & B serology, screening for Hepatocellular carcinoma (HCC) with Alpha fetoprotein (AFP) and imaging with Ultrasound or CT scan, variceal screening by EGD and vaccinations to Hepatitis A , B, Flu and Pneumonia. Cumulative performance feedback was distributed to providers (table 1). Charts were prospectively assessed at 30 & 60 days to examine impact of feedback on QI measures. Interval reports were subsequently distributed. Results: Two hundred & sixty five charts were included for retrospective part of study. A cumulative report was electronically distributed to providers. Charts were then reviewed prospectively and 30 and 60 days performance reports were distributed to providers. Variceal screening compliance improved by 10% (30 days) and 20% (60 days). AFP documentation improved
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AASLD Abstracts
IV, RR 1.6 CI 1.5-1.8 and stage V, RR 1.6 CI 1.4-1.8), being underweight (RR 1.3 CI 1.11.4), and being a smoker within 1 year of surgery (RR 1.1 CI 1.0-1.2). Diabetes and cardiovascular disease were not significantly associated with mortality. For every 0.1-point increase in serum albumin, there was a 2.7% (p<0.001) decrease in the mortality risk. For every 0.1-point increase in the INR, there was a 1.5% (p<0.001) increase in mortality risk. Type of surgery (cardiac, thoracic, orthopedic, vascular or open abdominal) was not a significant predictor of mortality on multivariate analysis. Laparoscopic surgery did carry a 44% risk reduction when compared to non-laparoscopic surgery types. Conclusion: We found that models used to predict mortality risk would likely benefit from consistently including age, nutritional status, smoking status and renal dysfunction all of which predict short-term surgical mortality. Laparoscopic approach should be considered whenever possible. Lack of association with surgery type, diabetes and cardiac disease may reflect appropriate pre-operative selection biases balancing these variables with surgical need. Mo1040
AASLD Abstracts
Predictors of Early Readmission in Patients Hospitalized With Cirrhosis Neil R. Volk, Zilla H. Hussain, Spencer L. James, Andree H. Koop, Swapna Sharma, Kerry Guyer, Rolland Dickson Background: The management of cirrhosis in the US is estimated to result in an annual cost of $9,576 to $22,424 per affected person. Hospital readmissions within a month of discharge are estimated to occur in 37% of patients, contributing significantly to cost and representing a potential area for improvement. Our aim was to identify factors that predict early readmission and to highlight those that may be modifiable. Methods: The study was a retrospective review of all patients admitted with a primary diagnosis of cirrhosis from 4/ 1/2011 to 12/31/2012 at a single tertiary care institution. Time to readmission, frequency of readmission, medications at time of discharge, length to primary care (PCP) follow up, length to gastroenterology (GI) follow up and lab values at time of discharge were examined. Odds ratios were calculated using univariate logistic regressions and are presented in Table 1. Results: 317 unique patients had a total of 498 admissions during the study period. The mean number of admissions per patient was 2.4, the average number of days to the next readmission was 88 days. The average age was 57.9 years, 58% were male. During the study period 11% of patients died during a hospital admission. The average length of stay was 7.3 days with an average cost per admission of $43,874. The percent readmitted within 30 days of the index admission was 8.3% and 15.6% within 60 days. Patients admitted on the index admission with hepatic encephalopathy were more likely to have readmissions (OR 3.12, p=0.008), while those admitted for a non-cirrhotic related cause were less likely to be readmitted (OR 0.56, p=0.005). A history of hepatocellular carcinoma was strongly linked with a risk for readmission (OR 7.25, p= 0.009), while etiology of underlying liver disease did not significantly affect the risk of readmission. There was no significant effect on readmission rates within 60 days of discharge by MELD score, laboratory tests, or medications prescribed. Follow up within 30 days either with primary care or Gastroenterology was associated with an increased odds of readmission (OR 1.5, p=0.02). Conclusion: Readmission of cirrhotic patients during a recent time interval was less frequent than previously reported. Admission for encephalopathy and HCC were associated with high risk of readmission and represent areas where more intensive outpatient intervention needs to be explored. Follow up within 30 days was associated with increased risk of readmission. Scheduled follow up earlier (within 7 days) could potentially allow intervention which could decrease readmission rates. This is currently being investigated at our institution. Association between primary diagnosis at admission and 60 day readmission in patients with Cirrhosis
Table 2: Results of multivariate analysis of HCC related admission
Adjusted for age, sex, insurance, income quartile, Elixhauser comorbidity burden, and hospital characteristics. The outcome of inpatient mortality was also adjusted for HCCrelated procedure. Mo1039 Surgical Mortality in Patients With Cirrhosis: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program, 20052012 Monica L. Schmidt, Paul H. Hayashi, Alfred S. Barritt
Table 1 Mo1041
Background: In the U.S., liver cirrhosis is expected to affect more than 1 million individuals by 2020. Like the general population, cirrhosis patients will have an increasing elderly demographic with more comorbidities. Traditional surgical risk scores that do not include age and comorbidities may not adequately reflect operative risk in these patients. We sought to define operative mortality risk factors among patients with cirrhosis looking specifically at age and comorbidities. Methods: This study used the American College of Surgeons National Surgical Quality Improvement Program data (NSQIP) from years 2005-2012. Data are collected through electronic medical records. 2,297,189 surgical cases were collected between 2005-2012. To identify patients with cirrhosis, first, all patients with an esophageal hemorrhage or ascites as identified by NSQIP were extracted. Second, patients with platelets <140, albumin<3.2 and INR>1.5 were subset from those with ascites or hemorrhage. Patients with cancer were excluded. Using a Poisson regression model with robust standard errors and 30-day mortality as our primary outcome, relative risk was reported for selected preoperative variables including pre-operative laboratory results, patient age, surgery type and comorbidities. Results: The diagnostic algorithm identified 23,731 patients with cirrhosis. Mean age was 58 years in 2005 and increased to 63 years by 2012. 52.8 % were male. 85.9% were Caucasian. Among patients with cirrhosis, factors that increase risk of postsurgical mortality for any surgery type were increasing age (2.1% increase in risk per year increase in age, CI 1.8-2.4), chronic kidney disease stage (stage III, RR 1.5 CI 1.3-1.6; stage
AASLD Abstracts
Patients Readmitted Post-Hospitalization for Complications of Cirrhosis Siamak M. Seraj, Emily J. Campbell, Sarah A. Keegan, James M. Richter Background and Aims-Currently, 30-day readmission post-hospitalization is both a quality of care metric and a fiscal goal, as such re-hospitalizations are costly and may result in financial penalties for health centers. Our institution has sought to improve the continuity of care for high-risk patients through post-discharge phone calls, as well as care management programs for chronic conditions such as heart disease and diabetes. We aim to extend such programs to patients with cirrhosis to improve clinical outcomes and reduce readmissions. We therefore sought to describe such patients and define the predictors of 30-day readmission in an inpatient cohort. Methods- We performed a retrospective study of 560 inpatient admissions for chronic liver disease in 2012 at a tertiary referral medical center. Of those, we studied 123 unique patients who were hospitalized due to complications of cirrhosis (245 admissions). Exclusion criteria included status post-transplant, advanced CHF or ESRD, and patients not followed at our center or who died after the index hospitalization. Univariate and Multivariate analyses were performed to describe variables associated with 30-day readmission. Results- Our patient cohort is described in Table 1. A total of 43 patients (35%) were readmitted at any time in 2012. Twenty-two (17%) patients had at least one readmission due to complications of cirrhosis within 30 days, while 40 (32%) were ultimately
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by 7% (30 days) and 17% (60 days). Imaging for HCC remained above 90% at 30 days and improved by 4% to 100% at 60 days. Pneumovax compliance improved by 17% (30 days) and 51% (60 days). Influenza vaccination was unchanged (30 days) and improved by 8% (60 days). Hepatitis A vaccination improved by 11% (30 days) and by 30% (60 days). Hepatitis B vaccination remained unchanged (30 days) and improved by 23% (60 days). Documenting hepatitis A serology improved by 18% (30 days) and sustained at this rate at 60 days. Hepatitis B serology improved by 37% (30 days) and 43 % (60 days). Discussion: Based on preliminary results periodic ‘cumulative provider performance feedback' is a simple and effective method to improve and maintain adherence to quality measures for cirrhosis. Long term maintenance of this intervention will be measured by assessing the data at 6 months and one year from baseline distribution of data. We are also creating a CPRS-based physician reminder system to document and assure further QI compliance.
AASLD Abstracts
readmitted within 90 days of discharge. The most common cause of 30-day readmission was hepatic encephalopathy (32%) followed by GI bleeding (18%), spontaneous bacterial peritonitis (18%) and volume overload (14%). Nearly half of these readmitted patients (46%) were hospitalized with the same index-admission complication. Thirty six percent (36%) and 27% of readmitted patients had ethanol and NASH/cryptogenic-related cirrhosis respectively. Mean MELD at admission and discharge were 16 and 14, respectively, for patients with at least one 30-day readmission. Logistic regression analysis showed hepatic encephalopathy at index as the only significant independent predictor of 30-day readmission (OR 6.89, 95% CI 2.11 - 22.5). Length of stay, discharge day of the week, marital status, education level, mental health status and etiology of liver disease were not significant predictors of readmission. Conclusion- Hepatologists are responsible for directing the continuous care and management of patients with liver disease. The measurement of readmissions therefore becomes an important metric of care for these patients. We found a 30-day readmission rate of 17% at our center, while 32% were readmitted within 90 days, with hepatic encephalopathy at index as the significant predictor for 30-day readmission. Through continued systematic study and intervention, we may be able to improve care for these costly and high-risk patients. Select characteristics of study cohort
Mo1043 A Natural Language Processing Alogrithm for Identification of Patients With Cirrhosis From Electronic Medical Records Robert Kung, Ariel Ma, John B. Dever, Jaya Vadivelu, Erika Cherk, Jejo D. Koola, Erik J. Groessl, Michael E. Matheny, Samuel B. Ho Objectives: The numbers of patients with cirrhosis is increasing and they are considered high risk/ high cost patients. Few patients receive liver biopsies for diagnosis and noninvasive methods of identifying cirrhotic patients are needed. Informatics technology, such as natural language processing (NLP) and statistical text mining (STM) can extract unstructured data from the electronic medical record which may improve upon the accuracy of current non-invasive markers of cirrhosis. The aim of this study was to test the sensitivity and specificity of a NLP algorithm for extraction of text data from an electronic medical record for identification of patients with cirrhosis. Methods: To test a NLP clinical alogrithm tool, we identified 270 consecutive patients who underwent liver biopsy from 2009-2012. Variables associated with presence or development of cirrhosis that were available prior to the biopsy were manually collected from radiology reports (cirrhosis assertion, liver contour, ascites, varices, splenomegaly), clinic notes (mention of cirrhosis, physical exam findings, ICD-9 based problem lists, and psychosocial risk factors, alcohol/substance abuse, marginal housing/homelessness, psychiatric disorder). Diagnostic accuracy was compared to commonly used non-invasive markers of cirrhosis APRI >1.5 and FIB4>3.25 and to liver biopsy. Results: Of 270 patients, 96% were male, and indications for liver biopsy included hepatitis C (70%), hepatitis B (10%), and nonalcoholic fatty liver disease (8%). 44/270 (16%) of the cohort had biopsy proven cirrhosis. The sensitivity and specificity of the factors used are indicated in the Table. Radiological findings associated with cirrhosis were present in 54% of cirrhotics overall. Physical exam findings indicative of cirrhosis were present in 10/44 (23%). Problem lists included cirrhosis in 24/44 (54%). High risk psychosocial factors occurred in 32/44 (73%). Compared with APRI alone, the use of APRI and/or Radiology findings increased sensitivity to 75% with specificity to 85%. The addition of NLP exam and note factors increased sensitivity to 75% with specificity to 80%. The use of problem lists or psychosocial factors did provide additional sensitivity; Conclusions: This natural language processing algorithm has the potential to increase the sensitivity identification of patients with cirrhosis in the EMR compared to commonly used non-invasive markers, primarily with application of radiology related factors. Further development of a NLP tool will be needed for identification and risk stratification of patients with cirrhosis from large patient populations.
Mo1042 Assessment of Adherence to Baseline Quality Measures for Cirrhosis and Impact of 'Performance Feedback' in a Regional VA Medical Center Jennifer Cahill, Syed Rizvi, Kia Saeian Background: Task forces on quality improvement appointed by various gastroenterology societies have published comprehensive guidelines to help better manage patients with cirrhosis. Data is scant on extent to which gastroenterologists and hepatologists adhere to recommended guidelines. Limited published data suggests suboptimal compliance with these quality indicators. Hence, there is a need to create a method to improve the adherence to quality improvement (QI) measures. Our aim is to assess baseline adherence to QI measures, develop a system to improve adherence by sending periodic provider performance feedback and measure the impact of feedback on QI over time. Methods: Using VA VINCI database, patients with diagnosis of cirrhosis seen in GI clinic at VA Medical Center between 2006 to 2012 were identified. Deceased patients or those seen only once in GI clinic were excluded. To assess baseline compliance with QI, ICD-9 and CPT codes were used to develop 6-year retrospective registry database. Charts were then reviewed for documentation of hepatitis A & B serology, screening for Hepatocellular carcinoma (HCC) with Alpha fetoprotein (AFP) and imaging with Ultrasound or CT scan, variceal screening by EGD and vaccinations to Hepatitis A , B, Flu and Pneumonia. Cumulative performance feedback was distributed to providers (table 1). Charts were prospectively assessed at 30 & 60 days to examine impact of feedback on QI measures. Interval reports were subsequently distributed. Results: Two hundred & sixty five charts were included for retrospective part of study. A cumulative report was electronically distributed to providers. Charts were then reviewed prospectively and 30 and 60 days performance reports were distributed to providers. Variceal screening compliance improved by 10% (30 days) and 20% (60 days). AFP documentation improved
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AASLD Abstracts