Discussion: Hospital readmissions in cirrhosis and the importance of treating alcohol use disorder

Aye, Lydia; Volk, Michael L.

doi:10.1016/j.dld.2020.03.023

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Previous studies have reported a relationship between alcoholism and not only liver cirrhosis but alcohol-related liver disease as well. Therefore, the increase in hospital admissions due to alcohol-related liver disease and liver cirrhosis might suggest that alcohol consumption increased in certain high-risk groups rather than in the whole population 15,16 . News that alcohol consumption among particular populations such as alcoholics actually increased might support this hypothesis [17][18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan

Itoshima

Shin

Takada

et al. 2021

Sci Rep

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During the coronavirus disease 2019 (COVID-19) pandemic, there have been health concerns related to alcohol use and misuse. We aimed to examine the population-level change in cases of alcohol-related liver disease and pancreatitis that required admission during the COVID-19 epidemic by interrupted time series (ITS) analysis using claims data. We defined the period from April 2020, when the Japanese government declared a state of emergency, as the beginning of the COVID-19 epidemic. This ITS analysis included 3,026,389 overall admissions and 10,242 admissions for alcohol-related liver disease or pancreatitis from 257 hospitals between July 2018 and June 2020. The rate of admissions per 1000 admissions during the COVID-19 epidemic period (April 2020–June 2020) was 1.2 times (rate ratio: 1.22, 95% confidence interval: 1.12–1.33) compared to the pre-epidemic period. Analyses stratified by sex revealed that the increases in admission rates of alcohol-related liver disease or pancreatitis for females were higher than for males during the COVID-19 epidemic period. The COVID-19 epidemic in Japan might associates an increase in hospital admissions for alcohol-related liver disease and pancreatitis. Our study could support the concern of alcohol consumption and health problems during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan

Itoshima

Shin

Takada

et al. 2021

Sci Rep

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“…12 Interventions that may decrease readmission rates include co-management inpatient models consisting of a hepatologist and hospitalist, 14 default options to order evidence-based medications, 15,16 prescribing rifaximin for HE, 17 care-management check-ups, 18 and treating concurrent alcohol use disorder. 19 Although best-practice guidelines exist for patients with cirrhosis, provider adherence to these practices remains low, [20][21][22][23] highlighting the need for specific interventions to close the quality gap between guidelines-based cirrhosis management and real-world practice. Among the possible provider-focused interventions aimed at quality improvement (QI), utilization of a standardized electronic medical record (EMR) note template incorporating evidence-based cirrhosis management has yet to be fully studied.…”

mentioning

confidence: 99%

“…Readmission reduction strategies must address modifiable risk factors, including undertreatment of HE and symptomatic ascites 12 . Interventions that may decrease readmission rates include co-management inpatient models consisting of a hepatologist and hospitalist, 14 default options to order evidence-based medications, 15,16 prescribing rifaximin for HE, 17 care-management check-ups, 18 and treating concurrent alcohol use disorder 19 …”

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confidence: 99%

Integration of Cirrhosis Best Practices Into Electronic Medical Record Documentation Associated With Reduction in 30-Day Mortality Following Hospitalization

Sherman

Wahid

Wagner

et al. 2022

Journal of Clinical Gastroenterology

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Background: Hospital admissions for patients with cirrhosis continue to increase. In New York City, 25% to 30% of hospitalized cirrhotics are readmitted within 30 days. Rehospitalization is associated with increased mortality, poor quality of life, and financial burden to patients, hospitals, and payers. Preventable readmissions are partially accounted for by a well-documented quality gap between evidencebased guidelines for cirrhosis management and real-world adherence to these recommendations. Methods:We performed a prospective cohort study that compared outcomes among cirrhotic patients admitted to 4 internal medicine teams over a 6-month period. An electronic medical record (EMR) note template that outlined best-practice measures for cirrhotics was developed. Inpatient providers on 2 teams were instructed to include it in daily progress notes and discharge summaries. The recommended practices included diagnostic paracentesis and diuretics for ascites, rifaximin, and lactulose for hepatic encephalopathy, beta blockers for esophageal varices, and antibiotic prophylaxis for spontaneous bacterial peritonitis. The remaining 2 teams continued the standard of care for cirrhotic patients. The primary outcome was 30-day readmissions. Secondary outcomes included in-hospital mortality, 30-day mortality, length of stay, and adherence to best-practice guidelines.Results: Over a 6-month period, 108 cirrhotic patients were admitted, 83 in the interventional group and 25 in the control group. MELD-Na scores on admission did not differ between the groups (20.1 vs. 21.1, P = 0.56). Thirty-day readmissions were not significantly different between the interventional and control groups (19.3% vs. 24%, P = 0.61). However, 30-day mortality was significantly lower in the interventional group (8.4% vs. 28%, P = 0.01). There was no difference between the 2 groups in in-hospital mortality (4.8% vs. 0%, P = 0.27), 90-day mortality (15.7% vs. 28.0%, P = 0.17) or length of stay (10.2 vs. 12.6 d, P = 0.34). Adherence to best-practice metrics was similar between the groups, except for rates of diagnostic paracentesis, which were higher in the interventional group (98% vs. 80%, P = 0.01). Conclusion:Implementation of an EMR note template with cirrhosis best practices was associated with lower 30-day mortality and higher rates of diagnostic paracentesis among admitted patients with cirrhosis. These findings suggest that the integration of best-practice measures into the EMR may improve outcomes in hospitalized cirrhotic patients. Larger studies are required to validate these findings.

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Clinicians’ perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis

Johnson

Ghosh

Daniels

et al. 2022

Addict Sci Clin Pract

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Background Alcohol use disorder (AUD) is one of the leading etiologies for liver cirrhosis and liver transplantation. Few individuals with AUD receive guideline-based care in the form of screening, brief intervention, referral to treatment, or prescription of pharmacotherapy for relapse prevention. We interviewed clinicians across Alberta to assess the current experience and perceived barriers to managing AUD in people who have cirrhosis. The aim of this paper is to summarize these findings to inform the development of an educational intervention. Methods We used a qualitative descriptive approach to explore the experiences of clinicians who care for patients with cirrhosis and AUD in Alberta. We conducted semi-structured interviews directed by an interview guide. Interviews were recorded and transcribed verbatim. We used an inductive thematic analysis approach whereby transcripts were coded, with codes grouped into larger categories, then themes. Results Sixteen clinicians participated in this study. Many participants acknowledged that they do not use a standardized approach to screening, brief intervention, and referral to treatment. Through thematic analysis we identified four themes surrounding barriers to managing AUD in patients with cirrhosis: (i) Practicing within knowledge constraints, (ii) Navigating limited resources and system challenges, (iii) Balancing the complexity of cirrhosis and AUD, and (iv) Acknowledging the influence of provider perceptions on care. Conclusion This article presents the perspectives of clinicians who care for people who have AUD and cirrhosis. Significant barriers exist, including limited knowledge and resources, systemic challenges, and patient complexity. The information gathered will be used to develop an educational intervention that will delve deeper into these issues in order to have the greatest impact on clinicians who routinely interface with this patient population.

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Discussion: Hospital readmissions in cirrhosis and the importance of treating alcohol use disorder

Cited by 3 publications

References 8 publications

The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan

The impact of the COVID-19 epidemic on hospital admissions for alcohol-related liver disease and pancreatitis in Japan

Integration of Cirrhosis Best Practices Into Electronic Medical Record Documentation Associated With Reduction in 30-Day Mortality Following Hospitalization

Clinicians’ perspectives and perceived barriers to caring for patients with alcohol use disorder and cirrhosis

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