BACKGROUND _ AIMS: Many hospitalized @entity1 with @entity82 are readmitted to the hospital within 30 days, particularly those with @entity99 ( @entity99 ). We performed a prospective study to assess the effects of a quality improvement protocol on readmission to a transplant center's liver unit within 30 days. METHODS: We studied the effects of a quality improvement program in 824 unique @entity1 with decompensated @entity82 or receiving liver transplants (mean Model for End-Stage @entity409 score, 17.7    7.4) admitted to an inpatient hepatology unit from 2010 through 2013. The study had a year-long control period (626 admissions receiving usual care) and 2 intervention phases: a hand-held checklist phase (470 admissions) and an electronic phase that incorporated the checklist items into the electronic provider order entry system (624 admissions). The intervention phases included goal-directed @entity11884 therapy and @entity1761 for overt @entity99 , and prompts for antibiotic prophylaxis of spontaneous @entity298 . The primary endpoint was the difference in 30-day readmissions between the control and intervention phases. Trends in 30-day readmissions were compared with those of @entity1 with decompensated @entity82 admitted at another center. RESULTS: During the electronic phase, study subjects had 40% lower adjusted odds of 30-day readmission than during the control period. The slope of the decline in readmissions over time was significantly greater than for @entity1 at the other center (P < .0001). The proportion of @entity1 with greater than grade 2 @entity99 and 30-day readmission was 48.9% (66 of 135) in the control period versus 26.0% (27 of 104) in the electronic phase (P  = .0003). Treatment of @entity99 with @entity1761 and secondary prophylaxis of spontaneous @entity298 with antibiotics (on  discharge) were associated with lower adjusted odds of readmission (odds ratios, 0.39 and 0.40, respectively). The electronic phase was associated with 1.34 fewer hospital days for @entity99 compared with the control period (P  = .01). CONCLUSIONS: In a prospective study, a quality improvement initiative that included electronic decision support reduced readmissions of @entity1 with @entity82 to the hospital within 30 days.

A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for XXXX With @entity82 .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity82 :: ('MESH:D005355', 'Disease') :: ['cirrhosis'] @entity11884 :: ('MESH:D007792', 'Chemical') :: ['lactulose'] @entity409 :: ('MESH:D008107', 'Disease') :: ['Liver Disease'] @entity1761 :: ('MESH:C042734', 'Chemical') :: ['rifaximin'] @entity99 :: ('MESH:D056486', 'Disease') :: ['hepatic encephalopathy', 'HE'] @entity298 :: ('MESH:D010538', 'Disease') :: ['bacterial peritonitis']
@entity1 :: (9606,Species) :: ['Patients']
