Conclusion: A provider-to-provider Hepatology
telemedicine service is a rewarding experience for PCPs that may improve provider knowledge, job satisfaction, and PCP-Hepatology integration. Future research is needed to study the effect of such an intervention on patient outcomes. Disclosures: Michael F. Chang – Advisory Committees or Review Panels: Nexavar, Kinase Inhibitor Library screening Nexavar, Nexavar, Nexavar; Consulting: Clinical Care Options, Clinical Care Options, Clinical Care Options, Clinical Care Options The following people have nothing to disclose: Lauren A. Beste, Raimund Pichler, Maureen Germani, Bessie Young Background & Aims: The severity of cirrhosis can be reduced by adherence to timely preventative care. Evidence-based quality indicators have been established to
provide standards-of-care and quality measurement. However, there are limited data regarding how often quality indicators are met, and what factors contribute to adherence. Methods: We evaluated preventive quality of care using 3 Delphi panel-derived quality indicators. Our evaluation involved 445 patients with cirrhosis seen at a tertiary-care hospital between 2006-2011. We conducted a chart review to identify justifiable Liproxstatin-1 research buy reasons for non-adherence. Results: Adherence rates to indicators, before exclusion of justifiable reasons, were 36% for hepatocellular carcinoma (HCC) surveillance, 56% for HAV immunization documentation, and 46% for HBV immunization documentation. Within the HCC surveillance indicator, patients who predominately saw a specialist for their care were more likely adherent than those who predominantly saw a primary care physician (PCP) (OR2.01;95%CI:1.19-3.40). Justifiable reasons for non-adherence were common for all indicators
with a majority due to loss to follow-up or death (>64%). Other reasons included allergy, patient refusal, or received a liver transplant. Excluding justifiable reasons, the adherence rates increased to 76% for HCC surveillance and 87% and 77% for HAV and HBV documentation, respectively. Comparison between specialist find more and PCP revealed no difference within any of the indicators after exclusion of justifiable reasons. Within the HCC indicator, patients were more likely adherent if they were decompensated (OR2.37;95%CI:1.06-5.31) and had private insurance (OR4.09;95% CI:1.35-12.44). Amongst the HAV indicator, adherence was more likely for females (OR2.12;95%CI:1.01-4.44), Whites (OR2.91;95%CI,1.25-6.76) had seen a specialist at least once (OR3.08;95%CI:1.34-7.04), or had private insurance rather than Medicare (OR2.66;95%CI:1.04-6.79) or Medicaid (OR4.51;95%CI:1.44-14.19). Adherence for HBV indicator was more likely for those younger than 60 years (OR1.95; 95%CI:1.09-3.51), had private insurance rather than Med-icaid (OR3.82;95%CI:1.47-9.94), or had seen a specialist at least once (OR2.88;95%CI:1.23-6.67).