PMID- 34374917
OWN - NLM
STAT- MEDLINE
DCOM- 20220608
LR  - 20240211
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Print)
IS  - 0163-2116 (Linking)
VI  - 67
IP  - 6
DP  - 2022 Jun
TI  - Inpatient Gastroenterology Consultation and Outcomes of Cirrhosis-Related 
      Hospitalizations in Two Large National Cohorts.
PG  - 2094-2104
LID - 10.1007/s10620-021-07150-8 [doi]
AB  - BACKGROUND: Little is known about use of specialty care among patients admitted 
      with cirrhosis complications. AIMS: We sought to characterize the use and impact 
      of gastroenterology/hepatology (GI/HEP) consultations in hospitalized patients 
      with cirrhosis. We studied two national cohorts-the Veterans Affairs Costs and 
      Outcomes in Liver Disease (VOCAL) and a nationally representative database of 
      commercially insured patients (Optum Clinformatics DataMart). METHODS: 
      Cirrhosis-related admissions were classified by ICD9/10 codes for ascites, 
      hepatic encephalopathy, alcohol-associated hepatitis, spontaneous bacterial 
      peritonitis, or infection related. We included 20,287/222,166 index admissions 
      from VOCAL/Optum from 2010 to 2016. Propensity-matched analyses were conducted to 
      balance clinical characteristics. Mortality and readmission were evaluated using 
      competing risk regression (subhazard ratios, sHR), and length of stay (LOS) was 
      assessed using negative binomial regression. RESULTS: GI/HEP consultations were 
      completed among 37% and 42% patients in VOCAL and Optum, respectively. In 
      propensity-matched analyses for VOCAL, GI/HEP consultation was associated with 
      adjusted estimates of increased LOS (1.55 + 1.03 additional days), 90-day 
      mortality (sHR 1.23, 95% CI 1.14-1.36), and lower 30-day readmissions (sHR 0.82, 
      95% CI 0.75-0.89). In Optum, inpatient consultation was associated with higher 
      LOS (1.13 + 1.01 additional days), higher 90-day mortality (sHR 1.57, 95% CI 
      1.43-1.72), and higher 30-day readmission risk (sHR 1.04, 95% CI 1.02-1.05). 
      Post-discharge primary and specialty care was higher among admissions receiving 
      GI/HEP consultation in both cohorts. CONCLUSIONS: Use of GI/HEP consultation for 
      cirrhosis-related admissions was low. Patients who received consultation had 
      higher disease severity, and consultation was not associated with lower mortality 
      but was associated with lower 30-day readmissions in the VA cohort only.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer Science+Business 
      Media, LLC, part of Springer Nature.
FAU - Serper, Marina
AU  - Serper M
AUID- ORCID: 0000-0003-4899-2160
AD  - Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman 
      School of Medicine, 3400 Spruce St, 2 Dulles, Philadelphia, PA, USA. 
      Marinas2@pennmediicne.upenn.edu.
AD  - Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA. 
      Marinas2@pennmediicne.upenn.edu.
AD  - Leonard Davis Institute of Health Economics, University of Pennsylvania, 
      Philadelphia, PA, USA. Marinas2@pennmediicne.upenn.edu.
FAU - Kaplan, David E
AU  - Kaplan DE
AD  - Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman 
      School of Medicine, 3400 Spruce St, 2 Dulles, Philadelphia, PA, USA.
AD  - Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
FAU - Lin, Menghan
AU  - Lin M
AD  - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, 
      USA.
FAU - Taddei, Tamar H
AU  - Taddei TH
AD  - VA Connecticut Healthcare System, West Haven, CT, USA.
AD  - Division of Gastroenterology, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Parikh, Neehar D
AU  - Parikh ND
AD  - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, 
      USA.
FAU - Werner, Rachel M
AU  - Werner RM
AD  - Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
AD  - Leonard Davis Institute of Health Economics, University of Pennsylvania, 
      Philadelphia, PA, USA.
AD  - Division of General Internal Medicine, University of Pennsylvania Perelman School 
      of Medicine, Philadelphia, PA, USA.
FAU - Tapper, Elliot B
AU  - Tapper EB
AD  - Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, 
      USA.
AD  - Gastroenterology Section, Ann Arbor Healthcare System, Ann Arbor, VA, USA.
LA  - eng
GR  - K23 DK115897/DK/NIDDK NIH HHS/United States
GR  - K23 DK117055/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20210810
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
SB  - IM
CIN - Dig Dis Sci. 2022 Jun;67(6):2105-2106. PMID: 34374918
MH  - Aftercare
MH  - *Gastroenterology
MH  - Hospitalization
MH  - Humans
MH  - Inpatients
MH  - Length of Stay
MH  - Liver Cirrhosis/complications/diagnosis/therapy
MH  - Patient Discharge
MH  - Patient Readmission
MH  - Referral and Consultation
MH  - Retrospective Studies
PMC - PMC10849043
MID - NIHMS1956954
OTO - NOTNLM
OT  - Access to care
OT  - Alcohol
OT  - Ascites
OT  - Hepatic encephalopathy
OT  - Liver disease
OT  - Quality
COIS- Conflict of interest Pertinent conflicts of interest: None. Elliot Tapper reports 
      advisory board participation with Bausch Health and Mallinckrodt; consulting with 
      Novartis and Allergan. Marina Serper reports consulting with Gilead Sciences, 
      Inc.
EDAT- 2021/08/11 06:00
MHDA- 2022/06/09 06:00
PMCR- 2024/02/07
CRDT- 2021/08/10 12:37
PHST- 2021/02/08 00:00 [received]
PHST- 2021/04/10 00:00 [accepted]
PHST- 2021/08/11 06:00 [pubmed]
PHST- 2022/06/09 06:00 [medline]
PHST- 2021/08/10 12:37 [entrez]
PHST- 2024/02/07 00:00 [pmc-release]
AID - 10.1007/s10620-021-07150-8 [pii]
AID - 10.1007/s10620-021-07150-8 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2022 Jun;67(6):2094-2104. doi: 10.1007/s10620-021-07150-8. Epub 2021 
      Aug 10.