CirrhosisRx CDS System

Each year, there over 200,000 hospitalizations for cirrhosis in the United States. Over one-third of these patients are readmitted within 30 days, and up to 10% will die in the hospital. Despite national quality measures and care guidelines, cirrhosis care remains suboptimal and highly variable.

Clinical Decision Support (CDS) systems present an attractive strategy to improve guideline-adherence due to low implementation costs. These systems, however, remain largely untested in cirrhosis care and it remains unknown whether they are effective at improving guideline-adherence and whether improving guideline-adherence changes clinical outcomes in cirrhosis care. The investigators have designed "CirrhosisRx," a cirrhosis-specific CDS system, to address these evidence gaps.

This study intends to compare effect of CirrhosisRx versus "usual care" on adherence to quality measures and clinical outcomes through a pragmatic randomized controlled trial (pRCT). Randomization will be based on stepped-wedge cluster randomization of treatment teams at our institution.

• CirrhosisRx CDS (Other): CirrhosisRx is a cirrhosis-specific CDS that organizes clinical data into clinically relevant groupings and links them to order sets consistent with national practice guidelines for inpatient cirrhosis care.

Primary outcomes

• Aggregate adherence to quality measures [During the hospitalization, approximately 7 days]: This outcome is the aggregate adherence to five American Gastroenterological Association (AGA) and American Association for the Study of Liver Disease (AASLD) quality measures applicable to hospitalized patients with cirrhosis. The calculation for the measure will be the total number of admissions satisfying the five AGA/AASLD quality measures divided by the total number of addressable admissions (e.g. hospitalizations in which these quality metrics could be applied). In the cases which an admission could satisfying two or more metrics, this single admission will be multiple times per the number of times metrics could be potentially applied.

Secondary outcomes

• Inpatient mortality [During the hospitalization, approximately 7 days]: This outcome is death during the admission

Other outcomes

• Reach of CirrhosisRx [Through study completetion, approximately 36 months]: Number of patients and clinicians randomized to CirrhosisRx
• Adoption of CirrhosisRx [Through study completetion, approximately 36 months]: Proportion of clinicians using CirrhosisRx in the intervention arm
• Implementation of CirrhosisRx [Through study completetion, approximately 36 months]: Proportions of clinicians implementing an order set through CirrhosisRx
• Maintenance of CirrhosisRx [Through study completetion, approximately 36 months]: Rate of use over time and contamination rate
• Average time spent on CirrhosisRx [Through study completetion, approximately 36 months]: Average time spent on CirrhosisRx - defined as the total time all clinicians spent on the system divided by the number of clinicians using the system

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* All adult (age ≥ 18 years) patients who have cirrhosis identified based on 1+ chronic liver disease and 1+ cirrhosis (or its complications) International Classification of Diseases, Revision 10 diagnosis codes OR mention of cirrhosis or portal hypertension (or their complications) in clinical documentation admitted at our institution.

Exclusion Criteria:

* Children (age < 18 years)
* patients who do not meet the cirrhosis definition criteria as noted above
* ambulatory patients

• Jin Ge, MD, MBA, Principal investigator, University of California, San Francisco