P2831 - Contributory Factors of Inadequate Clinical Follow-up After Improved Adherence to Esophageal Variceal Surveillance Documentation and Management Recommendations Through an Automated Endoscopy Template

Award: Presidential Poster Award

Award: Presidential Poster Award

Nghiem B. Ha, MD, MAS, Jin Ge, MD, MBA, Annsa C. Huang, MD, Alexis Bayudan, MD, Courtney B. Sherman, MD, Danielle Brandman, MD, MAS
University of California, San Francisco, San Francisco, CA

Introduction: Esophageal varices (EV) are a significant cause of morbidity/mortality in patients with cirrhosis. Effective and timely management of EV through adequate esophagogastroduodenoscopy (EGD) follow-up improves outcomes. In this two-part quality improvement study, we aimed (1) to improve adherence on EV management recommendations by developing automated endoscopy templates, and (2) to assess the clinical implementations of these recommendations to evaluate potential barriers of adherence.



Methods: For part 1, a pre-post study was conducted between 1/2018-3/2020 after implementation of automated endoscopy templates to standardize follow-up recommendations; primary outcomes included adherence to follow-up of (1) ≤2 years for small EV, (2) ≤3 months for medium/large EV or EV ligation, or (3) initiation of a nonselective betablocker. For part 2, only patients with recommended EGD follow-up <3 months between 1/2019-12/2019 were included, with the primary outcome being adherent to recommended EGD <3 months.

Results: For part 1, rate of adherence to guideline-based recommendation improved quarterly from 63% to 74%, 80%, and 94% following the implementation of automated endoscopy templates. For part 2, among 77 patients with recommended EGD follow-up <3 months, 49 (64%) patients had adequate follow-up. Reasons for inadequate follow-up among 28 (36%) patients included: death (24%), hospitalized/medical reasons (21%), no-show (7%), and procedure not scheduled (29%) or canceled (11%). Besides a higher proportion of men having inadequate follow-up (82% vs 45%,p=0.001), there were no statistically significant differences among patients with and without adequate follow-up in terms of patient demographic/socioeconomic-, clinical-, and procedural-factors (Table 1). Although not statistically significant, patients not followed by subspecialty care had slightly higher rates of inadequate follow-up (25% vs 14%; OR 2.28,p=0.17).

Discussion: Although our intervention of utilizing automated endoscopy templates led to a 31% improved rate of appropriate EV management recommendations, one-third of patients did not have adequate EGD follow-up within the recommended interval. Contributory factors include system-based barriers to procedure scheduling rather than patient demographic/socioeconomic-, clinical-, or procedural-factors. Clinical emphasis should be placed on timely scheduling and/or referral to subspecialty care in patients with EV to ensure adequate follow-up, especially given its high morbidity and mortality.



Disclosures:


Nghiem B. Ha, MD, MAS, Jin Ge, MD, MBA, Annsa C. Huang, MD, Alexis Bayudan, MD, Courtney B. Sherman, MD, Danielle Brandman, MD, MAS. P2831 - Contributory Factors of Inadequate Clinical Follow-up After Improved Adherence to Esophageal Variceal Surveillance Documentation and Management Recommendations Through an Automated Endoscopy Template, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.