studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 477A
537
Physician versus Patient Perceptions of Medical Care
Quality in Primary Biliary Cirrhosis
Andrew Saich, Herbert Swanson, Tracy J. Mayne; Intercept Pharmaceuticals,
Inc., San Diego, CA
Numerous studies have demonstrated significant self-enhancement
bias in physician perceptions of medical care delivery, in
which physicians rate care delivery more highly than patients.
Objective: To compare patient and physician perceptions of
care in patients with primary biliary cirrhosis (PBC) and the
hepatologists and gastroenterologists treating PBC patients,
with the goal of improving care delivery. Methods: From
December 11, 2014 to January 12, 2015, we conducted surveys
with board certified gastroenterologists (262) and hepatologists
(60) practicing for at least two years and had treated
at least two PBC patients in the past six months. From January
5-30, 2015, we conducted surveys with 214 patients with PBC
who were under a physician’s care. Results: The figure shows
physician and patient ratings of their confidence in physician
delivery of 7 areas of PBC care. Only 2 areas differed by more
than 5 points: physicians under-rated their skills in helping
patients manage PBC symptoms by a mean 6 points, and overrated
their bedside manner by a mean 10 points, compared to
patient ratings. Beyond care provisions, there were meaningful
differences between patients and physicians perceptions on
how PBC affects patient health-related quality of life. Half of
PBC patients reported that PBC impacts a “great deal” how
they feel physically (50% vs. 25% physicians), their ability
to work (39% vs. 16% physicians), and their ability to do the
things they enjoy (36% vs. 17% physicians). Despite the impact
of PBC on these symptoms, only 42% of patients strongly agree
that additional treatment options would treat PBC more effectively
(versus 65% of physicians). Conclusion: Hepatologists
and gastroenterologists do not demonstrate systematic self-enhancement
bias in treating PBC patients. While they may overrate
their bedside manner, they underrate their management
of PBC symptoms. However, physicians and patients both
rated diagnosis and treatment more highly than monitoring
disease progression and managing symptoms, and physicians
recognize the need to improve practice. If physicians’ estimation
and management of patient quality of life improves, then
patient perception of the treatment effectiveness and optimism
toward treatment innovation may also improve. Interventions to
improve physician communication around disease progression,
and patient communication around symptoms and symptom
management could enhance practice.
Disclosures:
Herbert Swanson - Management Position: Intercept
Tracy J. Mayne - Employment: Intercept Pharmaceuticals
The following authors have nothing to disclose: Andrew Saich
538
Redesigning Outpatient Care to Reduce 30-day Hospital
Readmissions Among Recent Liver Transplant Recipients.
Chanda Ho, Nina Topic, Raphael Merriman, Robert W. Osorio,
Garrett M. Hisatake, R Todd Frederick; California Pacific Medical
Center, San Francisco, CA
Background: Hospital readmission after liver transplantation
(LT) is associated with reduced patient and graft survival and
represents a growing health care burden. Prevention of hospital
readmission has been an area of focus by the Centers
for Medicare and Medicaid Services with reduced payments
for readmissions for certain diagnoses. However, hospital
readmissions and strategies to reduce them among recent LT
recipients have not been well characterized. Methods: We
collected baseline hospital readmission data following LT to
our medical center from 2010-2012. Reasons for readmission
were reviewed by a hepatologist and a surgeon. We captured
median length of stay (LOS) both after LT and during readmission.
Based on these data, in October 2012, we implemented
a quality improvement project to reduce our readmission rates.
Readmission data post-intervention were collected for 2013
and 2014. Results: Our 30-day post-LT hospital readmission
rates in 2010, 2011, and 2012 were 40%, 42%, and 43%
respectively. A high proportion of readmissions had a short
LOS (≤ 2days):47% and 48% in 2011 and 2012, respectively.
The reviewers determined a significant proportion of these
admissions could have been managed in the outpatient setting.
Barriers to care management identified included difficulty
scheduling multiple, often complex procedures in the outpatient
setting. The organization of post transplant care involving multiple
expedited procedures (e.g. interventional radiology, endoscopy)
was streamlined to optimize outpatient care coordination
and delivery for the commonly required diagnostic and therapeutic
procedures (e.g. ERCP, liver biopsy, ultrasound). Thirty-day
readmission rates declined in 2013 and 2014 to 25%
and 26%, respectively (p