Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease

Yoder, Lindsay; Mladenovic, Andrea; Pike, Francis; Vuppalanchi, Raj; Hanson, Haleigh; Corbito, Laura; Desai, Archita P.; Chalasani, Naga; Orman, Eric S.

doi:10.1016/j.amjmed.2021.09.016

Cited by 6 publications

(5 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Commonly evaluated interventions targeted patients, providers, and the system. Patient-targeted interventions that have been previously tested include the use of outreach reminders to patients, improved patient education, and the use of outreach nurses [43][44][45][46][47][48][49][50] . Provider-targeted interventions included clinical reminders in the electronic medical record to remind providers to order HCC surveillance, inform them of overdue HCC surveillance, or to alert them to missed patient appointments, the use of provider compliance reports, and provider education [24,46,[50][51][52] .…”

Section: Discussionmentioning

confidence: 99%

Barriers to surveillance for hepatocellular cancer among patients with chronic liver disease -providers' perspectives

Beal,

Gorji,

Volney

et al. 2023

Hepatoma Res

View full text Add to dashboard Cite

Aims: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. While patients who are known to be at high risk for HCC should be under surveillance, only 20% of eligible patients in the United States are surveilled. The aim of this study was to identify providers’ perspectives about patient-, provider- and system-level barriers to surveillance for HCC among high-risk patients and to examine provider knowledge and attitudes related to HCC surveillance. We also explored interventions providers suggested as ways to improve HCC surveillance. Methods: Purposive sampling was used to recruit physicians and nurse practitioners in hepatology, gastroenterology, and primary care (internal and family medicine) from one academic medical center to participate in semi-structured interviews. Interviews were transcribed verbatim, and analyzed deductively and inductively to reveal emergent themes. Results: 22 informants were interviewed. During these interviews, several important themes emerged, including: (1) Provider comfort with managing chronic liver disease and the relationships between hepatology, gastroenterology, infectious disease, and primary care providers; (2) Provider knowledge of guidelines for HCC surveillance in high-risk patients and their knowledge about the impact that HCC surveillance can have; (3) How providers discuss HCC surveillance with their high-risk patients; (4) Provider-Level barriers to surveillance; (5) System-level barriers to surveillance; (6) COVID-19; (7) Patient-level barriers to surveillance, and (8) Suggested interventions to improve HCC surveillance rates. Conclusions: In designing interventions to improve HCC surveillance rates of high-risk patients in the United States, there are important targets at the patient, provider and system levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Barriers to surveillance for hepatocellular cancer among patients with chronic liver disease -providers' perspectives

Beal,

Gorji,

Volney

et al. 2023

Hepatoma Res

View full text Add to dashboard Cite

show abstract

“…Importantly, we found patients with alcohol relapse were four to six times more likely to be readmitted compared to patients without alcohol relapse, which underscores the importance of treating alcohol use disorder (AUD) in this patient population. Potential interventions that could decrease alcohol relapse include prescribing AUD pharmacotherapy on discharge, 27 early clinic follow-up post-discharge 28,29 and early enrolment into an alcohol rehabilitation program. 30 However, the feasibility and validity of these strategies require further study.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Gaurnizo‐Ortiz,

Nephew,

Vilar‐Gomez

et al. 2023

Liver International

Self Cite

View full text Add to dashboard Cite

Background and AimsLittle is known about the clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis (mAH) as compared to severe alcohol‐associated hepatitis (sAH). Therefore, we aimed to describe the clinical characteristics and risk factors associated with mortality in hospitalized mAH patients.MethodsPatients hospitalized with alcohol‐associated hepatitis (AH) from 1 January 2010 to 31 December 2020 at a large US healthcare system [11 hospitals, one liver transplant centre] were retrospectively analysed for outcomes. Primary outcome was 90‐day mortality. AH and mAH were defined according to NIAAA Alcoholic Hepatitis Consortia and Model for End‐stage Liver Disease Score ≤ 20 respectively. Multivariable Cox regression analysis was performed to identify independent risk factors associated with 90‐day mortality.Results1504 AH patients were hospitalized during the study period, of whom 39% (n = 590) had mAH. Compared to sAH patients, mAH patients were older (50 vs. 48 years, p < 0.001) and less likely to have underlying cirrhosis (74% vs. 83%, p < 0.001). There were no differences between the two groups for median alcohol intake g/day (mAH 140.0 vs. sAH 112.0, p = 0.071). The cumulative proportion surviving at 90 days was 88% in mAH versus 62% in sAH (p < 0.001). On multivariable analysis, older age [HR 1.03 (95% CI 1.00–1.06), p = 0.020], corticosteroid use [HR 1.80 (95% CI 1.06–3.06), p = 0.030] and acute kidney injury (AKI) [HR 2.43 (95% CI 1.33–4.47), p = 0.004] were independently associated with 90‐day mortality.ConclusionsmAH carries a 12% mortality rate at 90 days. Age, AKI and corticosteroid use were associated with an increased risk for 90‐day mortality. Avoidance of corticosteroids and strategies to reduce the risk of AKI could improve outcomes in mAH patients.

show abstract

“…A close examination of the preventable readmissions in this study reveals that the top opportunities for improving outcomes are to facilitate timely outpatient paracentesis, coordinate close monitoring of diuretic effects, ensure an adequate supply of medications for HE, and reinforce appropriate dosing of lactulose. These time-sensitive tasks are best addressed soon after discharge by health care providers with expertise in the management of cirrhosis complications (33). These findings also highlight the importance of collaboration with other health care team members in transitional care (e.g., radiology for paracentesis, social work and pharmacy for ensuring coverage and access to lactulose and rifaximin).…”

Section: Discussionmentioning

confidence: 99%

“…Despite these features, its generalizability may be limited because it is a single-center study. Secular changes in health system management of readmission risk could also have affected the results; a transitional care quality initiative was implemented at our center in 2019 (33). However, there were no clear temporal trends in preventable or nonpreventable readmissions (see Supplementary Figure, Supplementary Digital Content, http://links.lww.com/AJG/D4), and other conditions targeted for readmission reduction (e.g., congestive heart failure, chronic obstructive pulmonary disease) were not associated with readmission in the study.…”

Section: Discussionmentioning

confidence: 99%

“…These findings also highlight the importance of collaboration with other health care team members in transitional care (e.g., radiology for paracentesis, social work and pharmacy for ensuring coverage and access to lactulose and rifaximin). Patient-centered collaborative care has been encouraged by Medicare, and there is emerging evidence of its effectiveness for the cirrhosis population (33,34).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Thirty-Day Readmissions Are Largely Not Preventable in Patients With Cirrhosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

Objectives: Hospital readmissions are common in cirrhosis, but there are few studies describing readmission preventability. We aimed to describe the incidence, causes, and risk factors for preventable readmission in this population. Methods: We performed a prospective cohort study of patients with cirrhosis hospitalized at a single center between June 2014 and March 2020 and followed for 30 days post-discharge. Demographic, clinical, and socioeconomic data, functional status, and quality of life were collected. Readmission preventability was independently and systematically adjudicated by 3 reviewers. Multinomial logistic regression was used to compare those with (1) preventable readmission, (2) non-preventable/death, and (3) no readmission. Results: Of 654 patients, 246 (38%) were readmitted, and 29 (12%) were preventable. Reviewers agreed on preventability for 70% of readmissions. Twenty-two (including 2 with preventable readmission) died. The most common reasons for readmission were hepatic encephalopathy (22%), gastrointestinal bleeding (13%), acute kidney injury (13%), and ascites (6%), and these reasons were similar between preventable and non-preventable readmissions. Preventable readmission was often related to paracentesis timeliness, diuretic adjustment monitoring, and hepatic encephalopathy treatment. Compared to non-readmitted patients, preventable readmission was independently associated with racial and ethnic minoritized individuals (OR 5.80; 95% CI, 1.96-17.13), non-married marital status (OR 2.88; 95% CI, 1.18-7.05), and admission in the prior 30 days (OR 3.45; 95% CI, 1.48-8.04). Conclusions: For patients with cirrhosis, readmission is common, but most are not preventable. Preventable readmissions are often related to ascites and hepatic encephalopathy and are associated with racial and ethnic minorities, non-married status, and prior admissions.

show abstract

Attendance at a Transitional Liver Clinic May Be Associated with Reduced Readmissions for Patients with Liver Disease

Cited by 6 publications

References 22 publications

Barriers to surveillance for hepatocellular cancer among patients with chronic liver disease -providers' perspectives

Barriers to surveillance for hepatocellular cancer among patients with chronic liver disease -providers' perspectives

Clinical characteristics and prognosis of hospitalized patients with moderate alcohol‐associated hepatitis

Thirty-Day Readmissions Are Largely Not Preventable in Patients With Cirrhosis

Contact Info

Product

Resources

About