[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-444679-105":59,"doc-detail-444679-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","quality-improvement-in-hepatology-requires-a-chronic-care-framework","Quality improvement in hepatology requires a chronic care framework","","Quality improvement in hepatology is often limited to episodic, single-site projects that target inpatient crises rather than the broader chronic liver disease trajectory. The document argues for a longitudinal QI framework grounded in the Chronic Care Model, integrating delivery system design, decision support, clinical information systems, self-management support, and community resources. It highlights how QI–CCM can automate detection and enable standardized workflows to prevent progression and sustain recovery, especially for alcohol use disorder and alcohol-associated liver disease.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/quality-improvement-in-hepatology-requires-a-chronic-care-framework/444679/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/quality-improvement-in-hepatology-requires-a-chronic-care-framework/444679.png","ImageObject",300,407,{"name":92,"@type":93},"Mary Man","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is traditional hepatology quality improvement often insufficient?","Question",{"text":112,"@type":113},"It is typically episodic and intervention-specific, occurring after initial decompensation and missing earlier opportunities in the disease course.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What framework is proposed to improve chronic liver disease care?",{"text":117,"@type":113},"A longitudinal QI framework aligned with the Chronic Care Model (CCM), applying its pillars simultaneously to CLD.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the QI–CCM approach address alcohol-associated liver disease?",{"text":121,"@type":113},"It creates a continuous, automated system linking detection directly to action, including screening, brief interventions, referral pathways, pharmacotherapy, and relapse prevention strategies.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},444679,1790819464,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39},7421720224475,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","DOI: 10.1097/HC9.0000000000000889  \nED ITO R IA L  \nQuality improvement in hepatology requires a chronic care framework  \nHepatology excels at managing crises. Hepatology practice involves routinely saving lives by treating acute decompensations like variceal bleeding. As highlighted in recent practice guidelines on portal hypertension, our patients’ care is being optimized by a continual process of innovation. [1] How these innovations are implemented broadly, however, is often haphazard. Efforts to standardize and optimize care, called “quality improvement (QI),” are generally episodic, single-site, intervention-specific projects that target discrete inpatient outcomes. [2] Most interventions address the management of crises with checklists, order sets, and educational initiatives. Though critical, they frequently occur after initial decompensation and miss opportunities earlier in the disease course. For example, hepatitis A and hepatitis B immunization can prevent severe harms, though vaccination rates among at-risk adults remain unacceptably low. [3] This illustrates a broader challenge: even when effective preventive interventions exist, they remain isolated from the larger chronic liver disease (CLD) care pathway. This separation underscores the need for a longitudinal QI framework in hepatology.  \nTHE CHALLENGE  \nHepatology can excel at preventing crises. By integrating QI across the whole trajectory of CLD, we can move from programs that achieve short-term gains to a program of prevention through sustainable, systemlevel improvement. Existing hepatology QI concepts focus on viral hepatitis immunization, fibrosis staging in metabolically at-risk persons,[4] and inpatient decompensation management. In primary care, incorporating the Chronic Care Model (CCM) has improved outcomes and reduced healthcare costs. [5] Applying this model to CLD has been proposed and represents an opportunity to reframe QI approaches by addressing the CCM pillars of health care organizations, delivery  \nsystem design, decision support, clinical information systems, self-management support, and community resources. [6] This gap creates an opportunity for hepatology to reimagine QI not as episodic project work, but as a longitudinal system of care aligned with the realities of chronic liver disease. A QI–CCM (Quality Improvement–Chronic Care Model) applies these pillars simultaneously and longitudinally to CLD, creating automated detection pathways, standardized clinical workflows, and closed-loop follow-up systems that prevent progression and sustain recovery. Adapting a QI–CCM approach to hepatology QI will shift the strategy from reactive to preventative.  \nOPPORTUNITY  \nAlcohol use disorder (AUD) is the quintessential chronic disease QI problem squarely within the purview of hepatology and an exemplar of the benefit of a QI–CCM approach. This approach is a continuous, automated system that links detection directly to action. Relapseprone and socially complex, AUD frequently leads to alcohol-associated liver disease (ALD) . While it might often be the first point of contact with the medical system, waiting until an episode of alcoholic hepatitis to intervene in ALD is clinically and ethically insufficient. Screening tools, brief interventions, referral pathways, pharmacotherapy initiation, and post-transplant relapseprevention strategies each represent distinct QI opportunities. [7,8] Given that ALD is now the leading indication for transplantation,[9] efforts to improve the quality of clinical care throughout the continuum should align with current practice guidelines. One of the recommended patient-reported outcomes in the practice metrics guidelines is the patient’s ability to avoid alcohol, which has been shown to be helped through integrated care models that combine hepatology and addiction services to reduce future decompensating events and hospitalizations. [10,11]  \nAbbreviations: ALD, alcohol-associated liver disease; AUD, alcohol us","cbCaivbOH4kSuPcQ","https://ap.wps.com/l/cbCaivbOH4kSuPcQ","pdf",156154,"English","# The Problem\n## Episodic QI vs longitudinal prevention\n## Preventing crises across the CLD trajectory\n# The Opportunity\n## Applying QI–CCM to alcohol use disorder","[{\"question\":\"Why is traditional hepatology quality improvement often insufficient?\",\"answer\":\"It is typically episodic and intervention-specific, occurring after initial decompensation and missing earlier opportunities in the disease course.\"},{\"question\":\"What framework is proposed to improve chronic liver disease care?\",\"answer\":\"A longitudinal QI framework aligned with the Chronic Care Model (CCM), applying its pillars simultaneously to CLD.\"},{\"question\":\"How does the QI–CCM approach address alcohol-associated liver disease?\",\"answer\":\"It creates a continuous, automated system linking detection directly to action, including screening, brief interventions, referral pathways, pharmacotherapy, and relapse prevention strategies.\"}]","Quality improvement in hepatology requires a chronic care framework | PDF",1790708862]