Table 3 Sample of Quality Measures (QMs)
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 |