First visit treatment decisions Selleckchem RG 7204 were made in 53% of cases, despite barriers such as the lack of information on disease stage (HCV) and serial ALT/HBV DNA (HBV). Feedback to PCPs on use of noninvasive tests for staging disease (HCV) and key serial labs (HBV) are next steps to improve referral effectiveness, enhance co-management, and optimize hepa-tologist care utilization. Disclosures: Norah Terrault – Advisory Committees or Review Panels: Eisai, Biotest; Consulting: BMS; Grant/Research Support: Eisai, Biotest, Vertex, Gilead, AbbVie, Novartis The following people have nothing to disclose: Chanda Ho, Nathaniel Gleason, Jennifer

Monacelli, Michael Wang, Don Collado, Ralph Gonzales Liver disease (LD) is a major cause of morbidity and mortality worldwide. Treatment options for LD patients have dramatically increased, as well as their costs. In spite of limited resources, the demand for better and higher quality care keeps growing, challenging the sustainability of health care systems. The availability of outcome indicators (OIs) may guide the decision making, so that efforts and resources can be allocated

according to the value of care (i.e. outcomes divided by their costs). Aim of our study was to generate and test a set of health care OIs for the major liver disease (hepatitis B, hepatitis C, cirrhosis, hepa-tocellular carcinoma (HCC), autoimmune liver diseases, NAFLD and liver transplant). In the first phase of the study, using a modified Delphi method, 7 expert panels composed by selleck kinase inhibitor 8–10 hepatologists, identified a preliminary set of OIs according to experience and scientific evidence (as of 2010). Each OI was rated Selleck Copanlisib using the RAND 9-point agreement scale. Median scores of each OI were calculated and used to rate again the OIs in the light of these results. After this second rating, a disagreement index (DI) was calculated to identify and accept (if DI<1) OIs with median rating >7. In the second phase, the final set of selected OIs was tested through

a prospective multicenter observational study involving three tertiary centers in Lombardy, Italy. Quality of life was assessed using the EQ-5D questionnaire. Patients are still being followed; we report an interim analysis on the early performance of the selected OIs. In 1 8 months, 3213 consecutive liver patients were recruited and prospec-tively followed in the three centers (median follow-up at this time, 1 3 months); 90% had at least one follow-up visit. Among these patients, 1 732 were cirrhotic (984 compensated and 748 decompensated) and 692 were affected by HCC. During observation time, 150 patients were transplanted and 197 patients died. All the identified OIs were successfully tested in the clinical setting and showed excellent performance, confirming the known natural history information. Significant differences in several OIs were found, as for instance in the annual decompensation rate of cirrhotic patients between the three centers (P<0.01).