• Fasiha Kanwal, Jennifer Kramer, Steven M Asch, Hashem El-Serag, Brennan M R Spiegel, Steven Edmundowicz, Arun J Sanyal, Jason A Dominitz, Kenneth R McQuaid, Paul Martin, Emmet B Keeffe, Lawrence S Friedman, Samuel B Ho, Francisco Durazo, and Bruce R Bacon.
• Saint Louis Veterans Administration (VA), Saint Louis University School of Medicine, Saint Louis, Missouri 63141, USA. fkanwal@yahoo.com
• Clin. Gastroenterol. Hepatol. 2010 Aug 1;8(8):709-17.

Background & AimsCirrhosis is a prevalent and expensive condition. With an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with cirrhosis, we established a set of explicit quality indicators (QIs) for their treatment.MethodsWe organized an 11-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for cirrhosis. We provided the panel with a report that summarized the results of a comprehensive literature review of data linking candidate QIs to outcomes. The panel performed independent ratings of each candidate QI by using a standard 9-point RAND appropriateness scale (RAS) (ranging from 1 = not appropriate to 9 = most appropriate). The panel members then met, reviewed the ratings, and voted again by using an iterative process of discussion. The final set of QIs was selected; QIs had a median RAS >7, and panel members agreed on those selected.ResultsAmong 169 candidate QIs, the panel rated 41 QIs as valid measures of quality care. The selected QIs cover 6 domains of care including ascites (13 QIs), variceal bleeding (18 QIs), hepatic encephalopathy (4 QIs), hepatocellular cancer (1 QI), liver transplantation (2 QIs), and general cirrhosis care (3 QIs). Content coverage included prevention, diagnosis, treatment, timeliness, and follow-up.ConclusionsWe developed an explicit set of evidence-based QIs for treatment of cirrhosis. These provide physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in any setting where care for patients with cirrhosis is provided.Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved.

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