Hospital based initiative to decrease readmission rates in end-stage liver disease

Abstract

Aim: To assess whether implementation of the care coordination program reduces 30-day readmissions, and identify characteristics that increase susceptibility to readmission. Methods:Our institution is an urban quaternary care liver transplant center performing approximately 50 liver transplants yearly in highly competitive UNOS Region 2. Our care coordination program focuses on patient education, short-term outpatient follow-up visits, and post-discharge follow-up calls by a transplant coordinator. During inpatient admission, patients deemed high-risk by attending hepatologists were enrolled. A retrospective chart review was conducted for all patients enrolled in care coordination from September 2014-April 2015. Basic demographic information, including age, gender, and ethnicity was collected. In addition, model for end-stage liver disease (MELD) score on index admission, as well as type of cirrhosis decompensation was recorded.Results: A total of 69 patients deemed high-risk for readmission were enrolled in the CC program. Of these patients, 30-day readmissions occured in 46.3%. There was no significant difference between MELD score on index admission for those readmitted within 30 days, and those who were not. Patients that were readmitted twice within a 30 day period, however, had an average MELD on index admission higher than those not readmitted within 30 days, with trend toward significance (24.3 vs. 19.1, p=0.07). Hepatic encephalopathy was the There were no differences between cirrhosis etiology, race, or type of decompensations between groups. A total of 15 post-transplant patients were included. Of those post-transplant patients who were readmitted within 30 days, the majority of them had recurrent HCV cirrhosis. Conclusion:Higher MELD scores portend increased chance of readmission, with encephalopathy being the most common reason for readmission.