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Table 3 Sample of Quality Measures (QMs)

From: The cirrhosis care Alberta (CCAB) protocol: implementing an evidence-based best practice order set for the management of liver cirrhosis - a hybrid type I effectiveness-implementation trial

Cirrhosis Care Alberta Order Set Domain Quality Measure Definition
Management of Cirrhosis complications
 Ascites *Patients undergoing large volume paracentesis (> 5 l removed) should receive intravenous albumin (6–8 g per liter removed)
 Hepatic hydrothorax *Patients with ascites and/or hepatic hydrothorax should be managed with both sodium restriction and diuretics (unless there is a contraindication for diuretics)
 Spontaneous bacterial peritonitis *Hospitalized patients with ascites, with an ascitic fluid polymorphonuclear count of ≥250 cells/mm3, should receive empiric antibiotics and albumin within 12 h of the test result. The first dose of albumin should be 1.5 g per kg body weight followed by a second infusion of 1.0 g/kg on day 3
 Spontaneous bacterial pleuritis *Hospitalized patients with a pleural fluid polymorphonuclear count of ≥500 cells/mm3 (or ≥ 250 cells/mm3 with positive culture), should receive empiric antibiotics within 12 h of the test result
 Renal dysfunction Patients with acute kidney injury should be given an intravenous albumin challenge of up to 100 g × 2 days.
 Hepatorenal syndrome Patients with cirrhosis and hepatorenal syndrome who have a MAP of < 65 mmHg should receive a combination of vasoconstrictors and albumin therapy
 Variceal bleed *Patients with cirrhosis who survive an episode of acute variceal hemorrhage should receive a combination of EVL (endoscopic variceal ligation) and β -blockers
 Hepatic encephalopathy *Patients who are discharged after an acute episode of hepatic encephalopathy should receive secondary prophylaxis with lactulose and/or rifaximin
 Alcoholic hepatitis Patients with ETOH hepatitis and a MELD score of > 20 should be considered for prednisone therapy provided there are no contraindications
Management of Broader health needs
 Advance care planning and goals of care Patients admitted with cirrhosis should have goals of care documented
 Alcohol use disorder *Patients with cirrhosis should receive counseling or be referred to a substance abuse treatment program within 2 months of positive screening
 Nutrition and physical activity optimization Patients admitted with cirrhosis should be prescribed a high protein/high calorie (± as needed, a low sodium) diet
Preparation for transition into the community
 Standardized cirrhosis education for patients/caregivers Patients with cirrhosis should receive cirrhosis education prior to discharge
 Post-discharge laboratory, diagnostic imaging and endoscopy appointments Patients with cirrhosis should receive information about when to have lab work done post discharge
 Post-discharge follow-up with primary and/or specialty care *Recently discharged patients with cirrhosis should have a clinic visit with a health care provider within 4 weeks of discharge
  1. Table includes a sample of the Quality Measures (QM) that will be evaluated from each domain of the Cirrhosis Care Alberta (CCAB) order set. Additional QMs will also be evaluated. QMs were selected based on consensus by either: *Practice Metrics Committee of the American Association for the Study of Liver Diseases [70], or consensus between the CCAB study team members