Practice guidelines define the criteria and standards of care in patients with cirrhosis and varices.
However, the extent to which the patients receive recommended care is largely unknown.
Dr Fasiha Kanwal and colleagues from Texas, USA evaluated the quality of varices related care and factors associated with receipt of such care.
The researchers conducted a retrospective cohort study of 550 patients with cirrhosis who sought care at 3 VA facilities between 2000 and 2007.
Using administrative and clinical data, the team assessed quality of varices care as measured by 8 explicit Delphi panel-derived quality indicators.
The research team also conducted a structured implicit review of patients’ medical records to explore the role of patients’ refusal, receipt of care outside the VA, or justifiable exclusions to certain care processes as explanations for non-adherence to the quality indicators.
Quality scores varied across individual indicators, ranging from 24% for upper endoscopy for varices screening to 72% for secondary prophylaxis for variceal bleeding.
Justifiable exclusions to indicated care documented in charts were common for primary prophylaxis in patients with varices, receipt of endoscopy, and endoscopic treatment in patients with active bleeding.
In contrast, the team observed that significant shortfalls remained in the receipt of screening endoscopy, use of beta-blockers, and use of somatostatin analogs, antibiotics, and secondary prophylaxis in patients with variceal bleeding.
Younger patients, those who saw a gastroenterologist, or those who were seen in the facility with academic affiliation received higher quality care.
Dr Kanwal's team concludes, "Health-care quality, measured according to whether patients received recommended varices-related care, was suboptimal in this health-care setting."
"Care that included gastroenterologists was associated with high quality."