Quality of Care for Patients with Cirrhosis and Treatment Outcomes in Phra Nakhon Si Ayutthaya Hospital


  • Kanit Bunnag Department of medicine, Phra Nakhon Si Ayutthaya Hospital
  • Dhanusorn Wanichagool Department of medicine, Phra Nakhon Si Ayutthaya Hospital
  • Sakkarin Chirapongsathorn Department of medicine, Phramongkutklao Hospital


Cirrhosis, quality of care, cost effectiveness analysis


As one of the leading causes of death in Thailand, the accurate data of cirrhosis are needed. The aims of this study were to examine the quality of care, costs and treatment outcomes of cirrhosis in Phra Nakhon Si Ayutthaya hospital. The cohort study was conducted involving all cirrhotic patients attending the hospital through 2020. Medical database was reviewed on the quality of care parameters as recommended in the standard practice guidelines, which included hepatocellular carcinoma screening, secondary prevention in variceal bleeding, diuretic for ascites, secondary prevention of spontaneous bacterial peritonitis, and secondary prevention of hepatic encephalopathy; and the rate of achievement were measured. Costs and outcomes were analyzed; and the results were reported as total and subgroup outcomes. There were altogether 706 cirrhotic patients identified. Among them, 43.6% were followed up at gastroenterology out-patient clinic (GI), 35.9% at internal medicine out-patient clinic (Med), and 20.4% at general physician out-patient clinic (GP). The emergency department visit rate, admission rate, and mortality rate were significantly increased in order of GI, Med, and GP group. While the quality of care was significantly decreased in the same order. The cost was not different in each group. The incremental cost-effectiveness ratio demonstrated cost-saving in GI over the other two groups, and cost-effectiveness in Med over the GP group. Despite a high disease burden and mortality rate of cirrhosis, the current quality of care was quite low, especially for those patients in Med and GP groups. Thus, the quality improvement campaign should be urgently established.


Download data is not yet available.


Stasi C, Silvestri C, Voller F, Cipriani F. Epidemiology of liver cirrhosis. J Clin Exp Hepatol 2015;5:272.

McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manag Healthc Policy 2016;9:143-56.

Poovorawan K, Treeprasertsuk S, Thepsuthammarat K, Wilairatana P, Kitsahawong B, Phaosawasdi K. The burden of cirrhosis and impact of universal coverage public health care system in Thailand: nationwide study. Ann Hepatol 2015;14:862-8.

Scaglione S, Kliethermes S, Cao G, Shoham D, Durazo R, Luke A, et al. The epidemiology of cirrhosis in the United States: a population-based study. J Clin Gastroenterol 2015;49:690-6.

Mellinger JL, Richardson CR, Mathur AK, Volk ML. Variation among United States hospitals in inpatient mortality for cirrhosis. Clin Gastroenterol Hepatol 2015;13:577-84.

Chirapongsathorn S, Poovorawan K, Soonthornworasiri N, Panngum W, Phaosawasdi K, Treeprasertsuk S. Thirty-day readmission and cost analysis in patients with cirrhosis: a nationwide population-based data. Hepatol Commun 2020;4:453-60.

Volk ML, Kanwal F. Quality of care in the cirrhotic patient. Clin Transl Gastroenterol 2016;7:e166.

Fagan KJ, Zhao EY, Horsfall LU, Ruffin BJ, Kruger MS, McPhail SM, et al. Burden of decompensated cirrhosis and ascites on hospital services in a tertiary care facility: time for change?. Intern Med J 2014;44:865-72.

สมาคมโรคตับแห่งประเทศไทย. แนวทางการดูแลผู้ป่วยมะเร็งตับในประเทศไทย ปี พ.ศ. 2564 (ฉบับปรับปรุง). กรุงเทพฯ: สมาคมโรคตับแห่งประเทศไทย; 2564.

Biggins SW, Angeli P, Garcia-Tsao G, Ginès P, Ling S, Nadim MK, et al. Diagnosis, evaluation, and management of ascites and hepatorenal syndrome. Virginia: American Association for the Study of Liver Diseases; 2021.

Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the study of liver diseases and the European Association for the study of the liver. Hepatology 2014;60:715-35.

Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American Association for the study of liver diseases. Hepatology 2018;68:723-50.

Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases. Hepatology 2017;65:310-35.

Bunnag K, Seetalarom N, Kongsompong A, Chirapongsathorn S. IDDF2019-ABS-0076 Quality of care and cost analysis for cirrhosis management in a large university-based hospital in Thailand. Gut 2019;68(Suppl 1):A128.

Singal AG, Yopp A, S Skinner C, Packer M, Lee WM, Tiro JA. Utilization of hepatocellular carcinoma surveillance among American patients: a systematic review. J Gen Intern Med 2012;27:861-7.

Goldberg DS, Taddei TH, Serper M, Mehta R, Dieperink E, Aytaman A, et al. Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis. Hepatology 2017;65:864-74.

McGowan CE, Edwards TP, Luong MT, Hayashi PH. Suboptimal surveillance for and knowledge of hepatocellular carcinoma among primary care providers. Clin Gastroenterol Hepatol 2015;13:799-804.

Singal AG, Tiro J, Li X, Adams-Huet B, Chubak J. Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system. J Clin Gastroenterol 2017;51:650-55.

Ho SB, Matheny ME, Schnabl BE. Changes in hospital admissions and mortality for complications of cirrhosis: implications for clinicians and health systems. Gut Liver 2016;10:8-9.

Tapper EB, Lai M. Factors affecting adherence to a quality improvement checklist on an inpatient hepatology service. Proc (Bayl Univ Med Cent) 2014;27:100-2.

Johnson EA, Spier BJ, Leff JA, Lucey MR, Said A. Optimising the care of patients with cirrhosis and gastrointestinal haemorrhage: a quality improvement study. Aliment Pharmacol Ther 2011;34:76-82.

Morando F, Maresio G, Piano S, Fasolato S, Cavallin M, Romano A, et al. How to improve care in outpatients with cirrhosis and ascites: a new model of care coordination by consultant hepatologists. J Hepatol 2013;59:257-64.



How to Cite

Bunnag ค, Wanichagool ด, Chirapongsathorn ศ. Quality of Care for Patients with Cirrhosis and Treatment Outcomes in Phra Nakhon Si Ayutthaya Hospital. JPMAT [Internet]. 2021 Sep. 7 [cited 2022 Jan. 24];11(2):370-87. Available from: https://he01.tci-thaijo.org/index.php/JPMAT/article/view/248802



Research Article