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

Sumeet K. Asrani; Marwan S. Ghabril; Alexander Kuo; Raphael B. Merriman; Timothy Morgan; Neehar D. Parikh; Nadia Ovchinsky; Fasiha Kanwal; Michael L. Volk; Chanda Ho; Marina Serper; Shivang Mehta; Vatche Agopian; Roniel Cabrera; Victoria Chernyak; Hashem B. El-Serag; Julie Heimbach; George N. Ioannou; David Kaplan; Jorge A Marrero; Neil Mehta; Amit Singal; Riad Salem; Tamar Taddei; Anne M. Walling; Elliot B. Tapper

doi:10.1002/hep.32240

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

Sumeet K. Asrani, Marwan S. Ghabril, Alexander Kuo, Raphael B. Merriman, Timothy Morgan, Neehar D. Parikh, Nadia Ovchinsky, Fasiha Kanwal, Michael L. Volk, Chanda Ho, Marina Serper, Shivang Mehta, Vatche Agopian, Roniel Cabrera, Victoria Chernyak, Hashem B. El-Serag, Julie Heimbach, George N. Ioannou, David Kaplan, Jorge A MarreroNeil Mehta, Amit Singal, Riad Salem, Tamar Taddei, Anne M. Walling, Elliot B. Tapper

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22 Scopus citations

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.

Original language	English (US)
Journal	Hepatology
DOIs	https://doi.org/10.1002/hep.32240
State	Accepted/In press - 2021

ASJC Scopus subject areas

Hepatology

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10.1002/hep.32240

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Asrani, S. K., Ghabril, M. S., Kuo, A., Merriman, R. B., Morgan, T., Parikh, N. D., Ovchinsky, N., Kanwal, F., Volk, M. L., Ho, C., Serper, M., Mehta, S., Agopian, V., Cabrera, R., Chernyak, V., El-Serag, H. B., Heimbach, J., Ioannou, G. N., Kaplan, D., ... Tapper, E. B. (Accepted/In press). Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases. Hepatology. https://doi.org/10.1002/hep.32240

Asrani, SK, Ghabril, MS, Kuo, A, Merriman, RB, Morgan, T, Parikh, ND, Ovchinsky, N, Kanwal, F, Volk, ML, Ho, C, Serper, M, Mehta, S, Agopian, V, Cabrera, R, Chernyak, V, El-Serag, HB, Heimbach, J, Ioannou, GN, Kaplan, D, Marrero, JA, Mehta, N, Singal, A, Salem, R, Taddei, T, Walling, AM & Tapper, EB 2021, 'Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases', Hepatology. https://doi.org/10.1002/hep.32240

@article{e17ca0d0934d47fdb10b011d64b76490,

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

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.",

author = "Asrani, {Sumeet K.} and Ghabril, {Marwan S.} and Alexander Kuo and Merriman, {Raphael B.} and Timothy Morgan and Parikh, {Neehar D.} and Nadia Ovchinsky and Fasiha Kanwal and Volk, {Michael L.} and Chanda Ho and Marina Serper and Shivang Mehta and Vatche Agopian and Roniel Cabrera and Victoria Chernyak and El-Serag, {Hashem B.} and Julie Heimbach and Ioannou, {George N.} and David Kaplan and Marrero, {Jorge A} and Neil Mehta and Amit Singal and Riad Salem and Tamar Taddei and Walling, {Anne M.} and Tapper, {Elliot B.}",

note = "Funding Information: Funding for the development of these practice measures was provided by the AASLD Publisher Copyright: {\textcopyright} 2021 American Association for the Study of Liver Diseases.",

year = "2021",

doi = "10.1002/hep.32240",

language = "English (US)",

journal = "Hepatology",

issn = "0270-9139",

publisher = "John Wiley and Sons Ltd",

}

TY - JOUR

T1 - Quality measures in HCC care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases

AU - Asrani, Sumeet K.

AU - Ghabril, Marwan S.

AU - Kuo, Alexander

AU - Merriman, Raphael B.

AU - Morgan, Timothy

AU - Parikh, Neehar D.

AU - Ovchinsky, Nadia

AU - Kanwal, Fasiha

AU - Volk, Michael L.

AU - Ho, Chanda

AU - Serper, Marina

AU - Mehta, Shivang

AU - Agopian, Vatche

AU - Cabrera, Roniel

AU - Chernyak, Victoria

AU - El-Serag, Hashem B.

AU - Heimbach, Julie

AU - Ioannou, George N.

AU - Kaplan, David

AU - Marrero, Jorge A

AU - Mehta, Neil

AU - Singal, Amit

AU - Salem, Riad

AU - Taddei, Tamar

AU - Walling, Anne M.

AU - Tapper, Elliot B.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

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U2 - 10.1002/hep.32240

DO - 10.1002/hep.32240

M3 - Article

C2 - 34778999

AN - SCOPUS:85121468189

SN - 0270-9139

JO - Hepatology

JF - Hepatology

ER -

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

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