Quality measures in HCC care by the Practice Metrics... : Hepatology (original) (raw)

SPECIAL ARTICLE

Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases

Asrani, Sumeet K.*,1; Ghabril, Marwan S.2; Kuo, Alexander3; Merriman, Raphael B.4; Morgan, Timothy5; Parikh, Neehar D.6; Ovchinsky, Nadia7; Kanwal, Fasiha8,9,10; Volk, Michael L.11; Ho, Chanda12; Serper, Marina13,14; Mehta, Shivang15; Agopian, Vatche16; Cabrera, Roniel17; Chernyak, Victoria18; El‐Serag, Hashem B.19; Heimbach, Julie20; Ioannou, George N.21; Kaplan, David22; Marrero, Jorge23; Mehta, Neil24; Singal, Amit25; Salem, Riad26; Taddei, Tamar27,28; Walling, Anne M.29,30; Tapper, Elliot B.31

122683Baylor University Medical CenterDallasTexasUSA

212250Division of GastroenterologyDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSA

3Division of GastroenterologyCedars‐Sinai Medical CenterUniversity of California Los AngelesLos AngelesCaliforniaUSA

4Division of General and Transplant HepatologyCalifornia Pacific Medical Center and Research InstituteSan FranciscoCaliforniaUSA

5Medicine and Research ServicesVA Long Beach Healthcare SystemLong BeachCaliforniaUSA

6Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA

7Division of Pediatric GastroenterologyChildren’s Hospital at MontefioreBronxNew YorkUSA

8Section of Gastroenterology and HepatologyDepartment of MedicineBaylor College of MedicineHoustonTexasUSA

9Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA

10Section of Health Services ResearchDepartment of MedicineBaylor College of MedicineHoustonTexasUSA

114608Division of Gastroenterology and Transplantation InstituteLoma Linda UniversityLoma LindaCaliforniaUSA

12Department of TransplantationCalifornia Pacific Medical CenterSan FranciscoCaliforniaUSA

13Division of Gastroenterology and HepatologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA

14Leonard Davis Institute of Health EconomicsPhiladelphiaPennsylvaniaUSA

15Baylor All SaintsFort WorthTexasUSA

16Division of Liver and Pancreas TransplantationDepartment of SurgeryDavid Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA

17Department of MedicineDivision of Gastroenterology, Hepatology and NutritionUniversity of FloridaGainesvilleFloridaUSA

18Department of RadiologyMontefiore Medical CenterBronxNew YorkUSA

19Department of MedicineBaylor College of MedicineHoustonTexasUSA

20Division of Transplant SurgeryWilliam J. von Liebig Transplant CenterMayo ClinicRochesterMinnesotaUSA

21Division of GastroenterologyDepartment of MedicineVeterans Affairs Puget Sound Health Care System and University of WashingtonSeattleWashingtonUSA

22Division of Gastroenterology and HepatologyPerelman University of Pennsylvania School of MedicinePhiladelphiaPennsylvaniaUSA

23Digestive and Liver Diseases DivisionDepartment of Internal MedicineUT Southwestern Medical CenterDallasTexasUSA

24Division of GastroenterologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA

25Division of Digestive and Liver DiseasesUT Southwestern Medical CenterDallasTexasUSA

26Division of Interventional RadiologyDepartment of RadiologyNorthwestern UniversityChicagoIllinoisUSA

27Section of Digestive DiseasesYale School of MedicineNew HavenConnecticutUSA

28VA Connecticut Healthcare SystemWest HavenConnecticutUSA

29VA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA

30Division of General Internal Medicine and Health Services ResearchUniversity of CaliforniaLos AngelesCaliforniaUSA

31Division of Gastroenterology and HepatologyDepartment of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA

* Correspondence
Sumeet K. Asrani, Baylor University Medical Center, 3410 Worth St Ste 860, Dallas, TX 75246, USA.
Email: [email protected]

Abstract

The burden of HCC is substantial. To address gaps in HCC care, the American Association for the Study of Liver Diseases (AASLD) Practice Metrics Committee (PMC) aimed to develop a standard set of process‐based measures and patient‐reported outcomes (PROs) along the HCC care continuum. We identified candidate process and outcomes measures for HCC care based on structured literature review. A 13‐member panel with content expertise across the HCC care continuum evaluated candidate measures on importance and performance gap using a modified Delphi approach (two rounds of rating) to define the final set of measures. Candidate PROs based on a structured scoping review were ranked by 74 patients with HCC across 7 diverse institutions. Out of 135 measures, 29 measures made the final set. These covered surveillance (6 measures), diagnosis (6 measures), staging (2 measures), treatment (10 measures), and outcomes (5 measures). Examples included the use of ultrasound (± alpha‐fetoprotein [AFP]) every 6 months, need for surveillance in high‐risk populations, diagnostic testing for patients with a new AFP elevation, multidisciplinary liver tumor board (MLTB) review of Liver Imaging‐Reporting and Data System 4 lesions, standard evaluation at diagnosis, treatment recommendations based on Barcelona Clinic Liver Cancer staging, MLTB discussion of treatment options, appropriate referral for evaluation of liver transplantation candidacy, and role of palliative therapy. PROs include those related to pain, anxiety, fear of treatment, and uncertainty about the best individual treatment and the future. The AASLD PMC has developed a set of explicit quality measures in HCC care to help bridge the gap between guideline recommendations and measurable processes and outcomes. Measurement and subsequent implementation of these metrics could be a central step in the improvement of patient care and outcomes in this high‐risk population.