PGI31 Health Care Indicators to Measure Quality of Care in Patients with Liver Diseases

Objective: Liver Diseases (LDs) are prevalent and generate high human and economic costs to the society. Efficient strategies of diagnosis and treatment are necessary to improve patients’ health and reduce costs. Our aim was to identify healthcare quality indicators (HCQIs) to measure quality of care provided to LD patients. Methods: This work was conducted using a modified Delphi methodology based on a two-stage rating process. We organized 7 expert panels, involving 8-10 hepatologists each. Each panel focused on one/few condition(s): hepatitis B, hepatitis C, cirrhosis, hepatocellular carcinoma, autoimmune hepatopathies and cholangiopathies, metabolic hepatopathies, liver transplant. For each condition a preliminary set of HCQIs was identified and discussed by the panel, according to evidence and experience. Then, each panel member performed a first independent rating of all HCQIs using the RAND 9-point agreement scale (RAS; 1=totally disagree to 9=totally agree). Median scores of each HCQI were calculated and then used to rate again the HCQIs in the light of these results. After this second rating, a disagreement index (DI) was calculated to identify and accept (if DI≤1) indicators with median RAS≥7. The final set of HCQIs was selected. Results: The final list included 8 valid HCQIs for hepatitis B, 7 for hepatitis C, 4 for compensated cirrhosis, 8 for decompensated cirrhosis, 10 for hepatocellular carcinoma, 12 for autoimmune hepatopathies and cholangiopathies, 11 for metabolic hepatopathies and 15 for liver transplant. Health-Related Quality-of-Life was included as a further HCQI in all conditions. Discussion: We identified and proposed a set of indicators as a tool to assess the quality of care provided to patients affected with LDs. After a validation process, which is being performed, their use could help clinicians and budget holders in understanding and improving the efficiency of the healthcare provided