Are hospitalists inferior to gastroenterologists at providing care for cirrhosis patients?

A recent study has shown that hospitalists provide quality of care similar to that given by gastroenterologists for patients hospitalized with decompensated cirrhosis.

A team of investigators conducted a retrospective cohort study of patients with decompensated cirrhosis admitted to gastroenterology or hospitalist service at the University of Michigan between 2016 to 2020.

Adherence to nationally recommended inpatient quality indicators for ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, and gastrointestinal bleeding was the primary outcome. Performance was calculated per patient admission as the proportion of quality indicators met compared with those for which the patient was eligible.

The investigators used t-tests to compare quality indicator scores between services. They also examined the impact of gastroenterology consultation on quality indicator scores for patients admitted to hospitalists. Finally, multivariable models adjusted for patient characteristics were fitted to compare clinical outcomes.

Of the 288 admissions included in the study, 155 were to gastroenterology service and 133 to hospitalist service. Quality indicator score for all admissions was 69.9±24.2 percent. Of note, quality indicator scores did not differ between gastroenterology and hospitalist services (69.6±23.6 percent vs 69.8±25.1 percent; p=0.913). No between-group difference was also observed in quality indicator subscores for each complication.

Hospitalists placed a gastroenterology consultation in more than half of admissions (53.4 percent). This correlated with higher albumin administration for patients with spontaneous bacterial peritonitis (57.1 percent vs 25 percent; p=0.044). In addition, patients admitted to gastroenterology service had higher 30-day readmissions (adjusted odds ratio [AOR], 1.95) and shorter length of hospitalization (AOR, 0.85).