PMID- 36843910
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230228
IS  - 2772-7246 (Electronic)
IS  - 2772-7246 (Linking)
VI  - 1
DP  - 2021 Dec
TI  - Alcohol use disorder treatment and outcomes among hospitalized adults with 
      alcoholic hepatitis.
PG  - 100004
LID - 10.1016/j.dadr.2021.100004 [doi]
LID - 100004
AB  - PURPOSE: : The burden of alcohol-associated liver disease (ALD) in the United 
      States (US) has continued to worsen in the background of rising rates of alcohol 
      use disorder. Patients with ALD present to care at a late stage, often with the 
      sequela of liver decompensation, such as gastrointestinal bleeding and infection. 
      ALD is now the leading indication for liver transplantation. We aimed to measure 
      the quality of care delivered to hospitalized patients with alcoholic hepatitis 
      (AH) across 3 domains: 1) alcohol-use disorder (AUD) care, 2) inpatient cirrhosis 
      care, and 3) alcohol-associated liver disease (ALD) care-and observe associations 
      between quality of care and outcomes. METHODS: : We included hospital encounters 
      between January 1, 2016 and January 1, 2019 to a large, diverse integrated health 
      system for AH with active alcohol use within the prior 60 days. The diagnosis of 
      AH was determined based on previously published clinical and laboratory criteria. 
      Quality indicator (QI) pass rates were calculated as the proportion of patients 
      eligible for each indicator who received the QI within the timeframe specified. 
      We then evaluated the association between the receipt of all QIs and 6-month 
      mortality, as well as AUD-specific QIs and 30-day readmission. RESULTS: : Of the 
      179 patients, the median age was 47 years-old, 59.2% were male and 49.2% were 
      non-Hispanic White. The median Model for End-Stage Liver Disease-Sodium score was 
      25, while the median discriminant function was 33. Patients were followed for an 
      average of 21 months. Overall, 14% of patients died during the index 
      hospitalization while 17.3% died following discharge and 24.8% were re-admitted 
      within 30-days. QI pass-rates were variable across the different domains. Few 
      patients received AUD care-pass rates for receipt of pharmacotherapy and 
      behavioral therapy at 6 months were only 19.1% and 35.1%, respectively. There was 
      a significant association between receiving behavioral therapy and 6-month 
      mortality-3% vs 18%, p = 0.05. CONCLUSION: : The quality of care received during 
      hospital encounters for AH is variable, and AUD-specific therapy is low. Future 
      quality of care initiatives are warranted to link patients to AUD treatment to 
      ensure optimal care and maximize patients survival in this at-risk population.
CI  - (c) 2021 The Authors.
FAU - Winters, Adam C
AU  - Winters AC
AD  - Vatche and Tamar Manoukian Division of Digestive Diseases, Department of 
      Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
FAU - May, Folasade P
AU  - May FP
AD  - Vatche and Tamar Manoukian Division of Digestive Diseases, Department of 
      Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
AD  - Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
AD  - Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
FAU - Wang, Yun
AU  - Wang Y
AD  - Vatche and Tamar Manoukian Division of Digestive Diseases, Department of 
      Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
FAU - Shao, Paul
AU  - Shao P
AD  - Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
FAU - Yang, Liu
AU  - Yang L
AD  - Vatche and Tamar Manoukian Division of Digestive Diseases, Department of 
      Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
FAU - Patel, Arpan A
AU  - Patel AA
AD  - Vatche and Tamar Manoukian Division of Digestive Diseases, Department of 
      Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
AD  - Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
LA  - eng
PT  - Journal Article
DEP - 20211117
PL  - Netherlands
TA  - Drug Alcohol Depend Rep
JT  - Drug and alcohol dependence reports
JID - 9918350383506676
PMC - PMC9948931
OTO - NOTNLM
OT  - Alcohol-associated liver disease
OT  - Alcohol-use disorder
OT  - Alcoholic hepatitis
COIS- The authors report no conflicts of interest.
EDAT- 2021/11/17 00:00
MHDA- 2021/11/17 00:01
PMCR- 2021/11/17
CRDT- 2023/02/27 03:59
PHST- 2021/09/14 00:00 [received]
PHST- 2021/11/04 00:00 [revised]
PHST- 2021/11/04 00:00 [accepted]
PHST- 2023/02/27 03:59 [entrez]
PHST- 2021/11/17 00:00 [pubmed]
PHST- 2021/11/17 00:01 [medline]
PHST- 2021/11/17 00:00 [pmc-release]
AID - S2772-7246(21)00004-4 [pii]
AID - 100004 [pii]
AID - 10.1016/j.dadr.2021.100004 [doi]
PST - epublish
SO  - Drug Alcohol Depend Rep. 2021 Nov 17;1:100004. doi: 10.1016/j.dadr.2021.100004. 
      eCollection 2021 Dec.