The Future of Quality Improvement for Cirrhosis.

Tapper, Elliot B; Parikh, Neehar D

Cirrhosis has a significant and growing impact on public health and patient reported outcomes. The increasing burden of cirrhosis has led to an emphasis on quality of care with the goal of improving overall outcomes in this high risk population. Existing evidence has shown the significant gaps in quality across process measures (e.g. hepatocellular carcinoma screening), highlighting the need for consistent measurement and interventions to address gaps in quality care. This multistep process forms the quality continuum and it depends on clearly-defined process measures, real-time quality measurement, and generalizable evaluative methods. Herein, we review the current state quality care in cirrhosis across the continuum with a focus on process measurement methodologies, developments in patient reported outcome evaluation on quality assessment, practical examples of quality improvement initiatives, and the recent emphasis placed on the value of primary prevention.