Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study

Oliver D. Tavabie; Abdullah Abbasi; Trainee Collaborative for Research and Audit in Hepatology UK; Jane Abbott; K.W.M Abeysekera; Kris Bennett; Paul Brennan; Ryan Buchanan; Amritpal Dhaliwal; Vasileios Galanakis; Tim Hardy; Rebecca Harris; Victoria T. Kronsten; Jess Leighton; Wenhao Li; James Liu Yin; Lucia Macken; Thomas Marjot; James B. Maurice; Hannah McDowell; Janardhan Navaratnam; Jeremy S. Nayagam; Keith Pohl; Emma Saunsbury; Jennifer Scott; Abhishek Sheth; Ricky Sinharay; Giovanna Sheiybani; Mohsan Subhani; Lucy Turner; Helen White; Nekisa Zakeri; Vinay K. Balachandrakumar; Nadir Abbas; Rahman Abdul; Mohamed Abdulaziz; Duaa Abduljabbar; Robbie Adamson; Danielle Adebayo; Aditya Kumar Adhikarla; Maciej Adler; Salman Ahmad; Shayan Ahmed; Mostafa Afifi; Ali Akram; Balqees Al Radhi; Ismaeel Al-Talib; Jolomi Alele; A.M Ali; Safa Almusai; Victoria Appleby; Huma Asmat; Sarah Astbury; Ali Atkinson; Fakhirah Badrulhisham; Alexandra Ball; Moses Banfa; Jeevan Barn; Shahnaz Begum; Katherine Belfield; Oliver Bendall; Rajan Bhandari; Prashan Bhatti; Meg Bradley; Edward Brown; Kathleen Bryce; Laura Burke; Roisin Campbell; Tamsin Cargill; Geraldine Carroll; James Cartledge; Devnandan Chatterjee; Rayan Chaundry; Zeshan Choudhry; Kathleen Clare; Jeremy Cobbold; Robert Coburn; Fintan Corvan; Rebecca Cox; Darren Craig; John Creamer; Christopher Curran; Shanika De Silva; Laurence Dean; Jayne Dillon; Rebecca Dunn; Robert Eckersley; Gidveig Eike; Amul Elagib; Ayman Elkholi; Omar Elshaarawy; Sarah Faloon; Francis Fan; Mohammad Fazili; Denzil Fernandes; James Fox; M Foxton; Waqas Gaba; Girish Gaikwad; Abishek Gairola; C Gallaher

doi:10.1136/flgastro-2023-102412

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Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study

Journal article

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Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study

Oliver D. Tavabie, Abdullah Abbasi, Trainee Collaborative for Research and Audit in Hepatology UK, Jane Abbott, K.W.M Abeysekera, Kris Bennett, Paul Brennan, Ryan Buchanan, Amritpal Dhaliwal, Vasileios Galanakis, …

Frontline gastroenterology, Vol.15(1), pp.3-13

01/2024

DOI: 10.1136/flgastro-2023-102412

PMCID: PMC10935520

PMID: 38487559

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Abstract

Introduction Specialist centres have been developed to deliver high-quality Hepatology care. However, there is geographical inequity in accessing these centres in the United Kingdom (UK). We aimed to assess the impact of these centres on decompensated cirrhosis patient outcomes and understand which patients transfer to specialist centres. Methods A UK multicentred retrospective observational study was performed including emergency admissions for patients with decompensated cirrhosis in November 2019. Admissions were grouped by specialist/non-specialist centre designation, National Health Service region and whether a transfer to a more specialist centre occurred or not. Univariable and multivariable comparisons were made. Results 1224 admissions (1168 patients) from 104 acute hospitals were included in this analysis. Patients at specialist centres were more likely to be managed by a Consultant Gastroenterologist/Hepatologist on a Gastroenterology/Hepatology ward. Only 24 patients were transferred to a more specialist centre. These patients were more likely to be admitted for gastrointestinal bleeding and were not using alcohol. Specialist centres eliminated regional variations in mortality which were present at non-specialist centres. Low specialist Consultant staffing numbers impacted mortality at non-specialist centres (aOR 2.15 (95% CI 1.18 to 4.07)) but not at specialist centres. Hospitals within areas of high prevalence of deprivation were more likely to have lower specialist Consultant staffing numbers. Conclusions Specialist Hepatology centres improve patient care and standardise outcomes for patients with decompensated cirrhosis. There is a need to support service development and care delivery at non-specialist centres. Formal referral pathways are required to ensure all patients receive access to specialist interventions.

cirrhosis

health service research

Details

Title: Subtitle: Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study
Creators: Oliver D. Tavabie
Abdullah Abbasi
Trainee Collaborative for Research and Audit in Hepatology UK
Jane Abbott
K.W.M Abeysekera
Kris Bennett
Paul Brennan
Ryan Buchanan
Amritpal Dhaliwal
Vasileios Galanakis
Tim Hardy
Rebecca Harris
Victoria T. Kronsten
Jess Leighton
Wenhao Li
James Liu Yin
Lucia Macken
Thomas Marjot
James B. Maurice
Hannah McDowell
Janardhan Navaratnam
Jeremy S. Nayagam
Keith Pohl
Emma Saunsbury
Jennifer Scott
Abhishek Sheth
Ricky Sinharay
Giovanna Sheiybani
Mohsan Subhani
Lucy Turner
Helen White
Nekisa Zakeri
Vinay K. Balachandrakumar
Nadir Abbas
Rahman Abdul
Mohamed Abdulaziz
Duaa Abduljabbar
Robbie Adamson
Danielle Adebayo
Aditya Kumar Adhikarla
Maciej Adler
Salman Ahmad
Shayan Ahmed
Mostafa Afifi
Ali Akram
Balqees Al Radhi
Ismaeel Al-Talib
Jolomi Alele
A.M Ali
Safa Almusai
Victoria Appleby
Huma Asmat
Sarah Astbury
Ali Atkinson
Fakhirah Badrulhisham
Alexandra Ball
Moses Banfa
Jeevan Barn
Shahnaz Begum
Katherine Belfield
Oliver Bendall
Rajan Bhandari
Prashan Bhatti
Meg Bradley
Edward Brown
Kathleen Bryce
Laura Burke
Roisin Campbell
Tamsin Cargill
Geraldine Carroll
James Cartledge
Devnandan Chatterjee
Rayan Chaundry
Zeshan Choudhry
Kathleen Clare
Jeremy Cobbold
Robert Coburn
Fintan Corvan
Rebecca Cox
Darren Craig
John Creamer
Christopher Curran
Shanika De Silva
Laurence Dean
Jayne Dillon
Rebecca Dunn
Robert Eckersley
Gidveig Eike
Amul Elagib
Ayman Elkholi
Omar Elshaarawy
Sarah Faloon
Francis Fan
Mohammad Fazili
Denzil Fernandes
James Fox
M Foxton
Waqas Gaba
Girish Gaikwad
Abishek Gairola
C Gallaher
Resource Type: Journal article
Publication Details: Frontline gastroenterology, Vol.15(1), pp.3-13
DOI: 10.1136/flgastro-2023-102412
PMID: 38487559
PMCID: PMC10935520
NLM abbreviation: Frontline Gastroenterol
ISSN: 2041-4137
eISSN: 2041-4145
Publisher: BMJ
Grant note: Guts UK: TRN2021_03
Guts UK (TRN2021_03).
Language: English
Electronic publication date: 07/06/2023
Date published: 01/2024
Academic Unit: Internal Medicine
Record Identifier: 9984844346002771

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