2024
Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration
McCurdy H, Nobbe A, Scott D, Patton H, Morgan T, Bajaj J, Yakovchenko V, Merante M, Gibson S, Lamorte C, Baffy G, Ioannou G, Taddei T, Rozenberg-Ben-Dror K, Anwar J, Dominitz J, Rogal S. Organizational and Implementation Factors Associated with Cirrhosis Care in the Veterans Health Administration. Digestive Diseases And Sciences 2024, 69: 2008-2017. PMID: 38616215, DOI: 10.1007/s10620-024-08409-6.Peer-Reviewed Original ResearchVeterans Affairs (VA) medical centersCirrhosis careDashboard usePopulation management toolCare processesSurveillance ratesDepartment of Veterans Affairs (VA) medical centersFactors associated with high performanceVeterans Health AdministrationHCC surveillanceSpecialty carePerceived barriersData Warehouse dataHealth AdministrationImplementation evaluationLinear regression modelsCareGastroenterology serviceMedical CenterMultivariate modelRegression modelsQuality measuresVeteransRate differencesWarehouse data
2023
Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis
John B, Dang Y, Kaplan D, Jou J, Taddei T, Spector S, Martin P, Bastaich D, Chao H, Dahman B. Liver Stiffness Measurement and Risk Prediction of Hepatocellular Carcinoma After HCV Eradication in Veterans With Cirrhosis. Clinical Gastroenterology And Hepatology 2023, 22: 778-788.e7. PMID: 38061410, PMCID: PMC10960676, DOI: 10.1016/j.cgh.2023.11.020.Peer-Reviewed Original ResearchSustained virological responseLiver stiffness measurementHepatitis C virusHepatocellular carcinomaHCV cirrhosisDiabetes mellitusAnnual riskChronic hepatitis C virusPortal hypertension-related complicationsRate of HCCRisk of HCCHypertension-related complicationsRetrospective cohort studyVeterans Health AdministrationStiffness measurementHCV eradicationVirological responseCohort studyC virusHCC riskLower riskCirrhosisCutoff levelHealth AdministrationAbstractTextThe Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis
Pulaski M, Bittermann T, Taddei T, Kaplan D, Mahmud N. The Association Between Homelessness and Key Liver-Related Outcomes in Veterans With Cirrhosis. The American Journal Of Gastroenterology 2023, 119: 297-305. PMID: 37782293, DOI: 10.14309/ajg.0000000000002535.Peer-Reviewed Original ResearchInverse probability treatmentCause mortalityCohort studyCox regressionHepatocellular carcinomaProbability treatmentVeterans Health Administration patientsLiver-related outcomesTime-updated variablesLiver-related mortalityRetrospective cohort studyCause-specific mortality analysesVeterans Health AdministrationRisk regression modelsCirrhosis decompensationCirrhosis diagnosisPatient outcomesPatientsHomeless patientsHealth AdministrationMortality analysisCirrhosisMortalityDrivers of mortalityDecompensationPerformance of an automated deep learning algorithm to identify hepatic steatosis within noncontrast computed tomography scans among people with and without HIV
Torgersen J, Akers S, Huo Y, Terry J, Carr J, Ruutiainen A, Skanderson M, Levin W, Lim J, Taddei T, So‐Armah K, Bhattacharya D, Rentsch C, Shen L, Carr R, Shinohara R, McClain M, Freiberg M, Justice A, Re V. Performance of an automated deep learning algorithm to identify hepatic steatosis within noncontrast computed tomography scans among people with and without HIV. Pharmacoepidemiology And Drug Safety 2023, 32: 1121-1130. PMID: 37276449, PMCID: PMC10527049, DOI: 10.1002/pds.5648.Peer-Reviewed Original ResearchConceptsSevere hepatic steatosisHepatic steatosisHIV statusLiver attenuationHounsfield unitsPredictive valueRadiologist assessmentUS Veterans Health AdministrationNoncontrast abdominal CTVeterans Health AdministrationCross-sectional studySample of patientsNegative predictive valueReal-world studyPositive predictive valueAbdominal CTLiver fatTomography scanSteatosisCT imagesHealth AdministrationPharmacoepidemiologic studiesRadiologist reviewHIVPercent agreement
2022
Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis
John BV, Ferreira RD, Doshi A, Kaplan DE, Taddei TH, Spector SA, Paulus E, Deng Y, Bastaich D, Dahman B. Third dose of COVID-19 mRNA vaccine appears to overcome vaccine hyporesponsiveness in patients with cirrhosis. Journal Of Hepatology 2022, 77: 1349-1358. PMID: 36181987, PMCID: PMC9519143, DOI: 10.1016/j.jhep.2022.07.036.Peer-Reviewed Original ResearchConceptsCOVID-19 mRNA vaccinesCritical COVID-19COVID-19-related deathsThird doseMRNA vaccinesCOVID-19Propensity-matched control groupRetrospective cohort studyModerate COVID-19Symptomatic COVID-19Veterans Health AdministrationBNT-162b2BNT162b2 mRNAModerna mRNACohort studyImmune dysregulationCirrhosisSimilar riskGeneral populationMagnitude of reductionPatientsControl groupHealth AdministrationVaccineAbstractTextType of Infection Is Associated with Prognosis in Acute-on-Chronic Liver Failure: A National Veterans Health Administration Study
Mahmud N, Reddy KR, Taddei TH, Kaplan DE. Type of Infection Is Associated with Prognosis in Acute-on-Chronic Liver Failure: A National Veterans Health Administration Study. Digestive Diseases And Sciences 2022, 68: 1632-1640. PMID: 36083379, PMCID: PMC9995592, DOI: 10.1007/s10620-022-07680-9.Peer-Reviewed Original ResearchConceptsSpontaneous bacterial peritonitisChronic liver failureShort-term mortalityLiver failureHigh short-term mortalityACLF grade 3Retrospective cohort studyUrinary tract infectionMultivariable logistic regressionVeterans Health AdministrationType of infectionInverse probability treatmentLarge national databaseSource of infectionACLF gradeMSK infectionsCohort studyTract infectionsBacterial peritonitisMusculoskeletal infectionsFrequent precipitantInfectious sourceGrade 3Relative oddsHealth Administration
2021
Rates of decompensation, hepatocellular carcinoma and mortality in AMA‐negative primary biliary cholangitis cirrhosis
John BV, Dahman B, Deng Y, Khakoo NS, Taddei TH, Kaplan DE, Levy C. Rates of decompensation, hepatocellular carcinoma and mortality in AMA‐negative primary biliary cholangitis cirrhosis. Liver International 2021, 42: 384-393. PMID: 34614294, PMCID: PMC8810619, DOI: 10.1111/liv.15079.Peer-Reviewed Original ResearchConceptsLiver-related deathAMA-negative PBCPBC cirrhosisHepatocellular carcinomaMale patientsAMA-positive patientsAMA-positive PBCLiver-related outcomesSimilar unadjusted ratesAnti-mitochondrial antibodiesSimilar ratesNumber of patientsVeterans Health AdministrationRate of decompensationDevelopment of deathUDCA responseOverall deathUnadjusted ratesCirrhosis diagnosisCirrhosisLarge cohortDecompensationPatientsHealth AdministrationNatural historyThe Predictive Role of Model for End‐Stage Liver Disease–Lactate and Lactate Clearance for In‐Hospital Mortality Among a National Cirrhosis Cohort
Mahmud N, Asrani SK, Kaplan DE, Ogola GO, Taddei TH, Kamath PS, Serper M. The Predictive Role of Model for End‐Stage Liver Disease–Lactate and Lactate Clearance for In‐Hospital Mortality Among a National Cirrhosis Cohort. Liver Transplantation 2021, 27: 177-189. PMID: 33025731, PMCID: PMC7880877, DOI: 10.1002/lt.25913.Peer-Reviewed Original ResearchConceptsEnd-stage liver diseaseHospital mortalityLactate clearanceCirrhosis hospitalizationsMELD-NaLiver diseaseDay 1Predictive roleRetrospective cohort studyIn-Hospital MortalityRisk-stratify patientsVeterans Health AdministrationCirrhosis cohortMELD categoriesGastrointestinal bleedingCohort studyClinical dataLimited cohortStratified analysisLactate levelsHospitalizationHealth AdministrationMELDClinical toolMortality
2020
Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans
Rogal SS, Yakovchenko V, Morgan T, Bajaj JS, Gonzalez R, Park A, Beste L, Miech EJ, Lamorte C, Neely B, Gibson S, Malone PS, Chartier M, Taddei T, Garcia-Tsao G, Powell BJ, Dominitz JA, Ross D, Chinman MJ. Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans. Implementation Science 2020, 15: 92. PMID: 33087156, PMCID: PMC7579930, DOI: 10.1186/s13012-020-01050-7.Peer-Reviewed Original ResearchConceptsVA Medical CenterCirrhosis careVeterans Health AdministrationEvidence-based practiceImplementation interventionsAim 1Stepped-wedge clusterBackground cirrhosisImplementation strategiesMedical CenterWedge clusterAim 3Health AdministrationEBP uptakeCirrhosisAim 2CareExpert recommendationsSuccessful implementation strategiesInterventionVeteransChange taxonomyImplementation support toolsProgram evaluationSemi-structured interviewsEffects of Metformin Exposure on Survival in a Large National Cohort of Patients With Diabetes and Cirrhosis
Kaplan DE, Serper M, John BV, Tessiatore KM, Lerer R, Mehta R, Fox R, Aytaman A, Baytarian M, Hunt K, Albrecht J, Taddei TH, Group V. Effects of Metformin Exposure on Survival in a Large National Cohort of Patients With Diabetes and Cirrhosis. Clinical Gastroenterology And Hepatology 2020, 19: 2148-2160.e14. PMID: 32798709, DOI: 10.1016/j.cgh.2020.08.026.Peer-Reviewed Original ResearchConceptsDiagnosis of cirrhosisEnzyme inhibitors/angiotensinMetformin exposureHepatic decompensationHepatocellular carcinomaDiabetes mellitusPrognosis of cirrhosisPropensity-matched approachPre-existing diabetesRetrospective cohort studyLarge national cohortVeterans Health AdministrationMarginal structural modelsConcomitant statinCohort studyMultiple medicationsStatin exposureNational cohortCirrhosisPatientsDiabetesDecompensationMetforminConcomitant exposureHealth AdministrationSurvival Benefit of Liver Transplantation for Hepatocellular Carcinoma.
Kanneganti M, Mahmud N, Kaplan DE, Taddei TH, Goldberg DS. Survival Benefit of Liver Transplantation for Hepatocellular Carcinoma. Transplantation 2020, 104: 104-112. PMID: 31283688, PMCID: PMC6928443, DOI: 10.1097/tp.0000000000002816.Peer-Reviewed Original ResearchConceptsIncremental survival benefitLiver transplantSurvival benefitHepatocellular carcinomaEnd-stage liver disease (MELD) scoreOverall long-term survivalIntermediate-stage hepatocellular carcinomaLiver Disease scoreRetrospective cohort studyStage hepatocellular carcinomaHazard of deathVeterans Health AdministrationImmortal time biasLong-term survivalUnderwent resectionLiver transplantationAnalytic cohortCohort studyCurative optionMultivariable modelHCC diagnosisDisease scoreResectionPatientsHealth Administration
2017
Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis
Goldberg DS, Taddei TH, Serper M, Mehta R, Dieperink E, Aytaman A, Baytarian M, Fox R, Hunt K, Pedrosa M, Pocha C, Valderrama A, Kaplan DE. Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis. Hepatology 2017, 65: 864-874. PMID: 27531119, DOI: 10.1002/hep.28765.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedCarcinoma, HepatocellularCohort StudiesEarly Detection of CancerFemaleHumansLinear ModelsLiver CirrhosisLiver NeoplasmsMagnetic Resonance ImagingMaleMiddle AgedMultimodal ImagingPopulation SurveillancePrevalenceProportional Hazards ModelsRisk AssessmentSeverity of Illness IndexSex FactorsTomography, X-Ray ComputedUltrasonography, DopplerUnited StatesUnited States Department of Veterans AffairsConceptsHCC surveillanceHepatocellular carcinomaPatients 75 yearsHepatocellular carcinoma surveillancePrimary care physiciansHigh-risk populationVeterans Health AdministrationOverall health care systemVeterans Administration CenterHealth care systemAbdominal ultrasoundCirrhosis patientsPrimary outcomeCare physiciansInverse associationCirrhosis diagnosisLeading causeOdds ratioPercentage of timeSurveillance ratesNumber of visitsHealth AdministrationPatientsCirrhosisCare system