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Implementation of a care bundle improves PBC management.

Rachel Smith1, Laura Burke2, Nadir Abbas3,4,5

  • 1Cambridge Liver Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

JHEP Reports : Innovation in Hepatology
|August 14, 2025
PubMed
Summary
This summary is machine-generated.

A new care bundle significantly improved management for primary biliary cholangitis (PBC) patients in the UK. This standardized approach enhanced adherence to quality standards and clinical outcomes across multiple hospitals.

Keywords:
Autoimmune liver diseaseFibratesObeticholic acidPrimary biliary cholangitisSecond-line therapyService evaluation

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Area of Science:

  • Hepatology
  • Clinical Quality Improvement
  • Patient Management

Background:

  • A 2021 UK-wide audit revealed significant deficiencies in primary biliary cholangitis (PBC) care within the National Health Service (NHS).
  • Recognizing these gaps, a study was initiated to develop and implement a standardized care approach for PBC patients.

Purpose of the Study:

  • To develop a Primary Biliary Cholangitis (PBC) care bundle.
  • To pilot this bundle in selected UK centers.
  • To re-evaluate adherence to quality standards in PBC management.

Main Methods:

  • A PBC care bundle was designed, integrating quality standards and British Society of Gastroenterology guidelines.
  • Twelve hospitals piloted the bundle from October 2023 to March 2024.
  • Clinical data were collected pre- and post-bundle implementation to assess changes in quality standard adherence.

Main Results:

  • Significant improvements in adherence to all quality standards were observed post-bundle implementation.
  • Two hospitals achieved target performance (≥90%) across all standards.
  • Key improvements included increased referral for second-line therapy (72% to 94%), symptom assessment (54% to 90%), bone health assessment (65% to 86%), hepatocellular carcinoma surveillance (67% to 97%), and varices screening (81% to 92%).

Conclusions:

  • The PBC care bundle effectively enhances adherence to management guidelines.
  • Widespread adoption of this bundle is crucial for improving the quality of care for all Primary Biliary Cholangitis patients.