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

Abstract

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.