Format

Send to

Choose Destination
Biochim Biophys Acta Mol Basis Dis. 2018 Apr;1864(4 Pt B):1415-1422. doi: 10.1016/j.bbadis.2017.08.025. Epub 2017 Aug 24.

Optimising the clinical strategy for autoimmune liver diseases: Principles of value-based medicine.

Author information

1
Division of Gastroenterology, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy.
2
Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.
3
International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy.
4
International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy; Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy.
5
Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
6
Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
7
FADE Foundation, Milan, Italy.
8
International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy; Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy.
9
Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy.
10
Division of Gastroenterology, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy; Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Electronic address: mario.strazzabosco@yale.edu.

Abstract

BACKGROUND:

Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy.

METHODS:

In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset.

RESULTS:

Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies.

CONCLUSIONS:

We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen.

KEYWORDS:

Autoimmune hepatitis; Primary biliary cholangitis; Primary sclerosing cholangitis; Value-based medicine

PMID:
28844954
DOI:
10.1016/j.bbadis.2017.08.025
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center