HEPACONTROL. A program that reduces early readmissions, mortality at 60 days, and healthcare costs in decompensated cirrhosis

B, Morales; Planas, Ramón; Bartolı́, Ramón; Morillas, Rosa; Sala, María; Casas, Irma; Armengol, Carolina; Masnou, Helena

doi:10.1016/j.dld.2017.08.024

Cited by 32 publications

(42 citation statements)

References 26 publications

(32 reference statements)

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“…Reduced guideline compliance has been associated with poor outcomes, including readmissions for overdiuresis, delayed hepatocellular carcinoma (HCC) diagnosis, reduced curative HCC treatment and increased oesophageal variceal haemorrhage 6 10 12. Quality improvement studies of decompensated cirrhosis have demonstrated improved patient outcomes by increasing practice guideline adherence 13–17. An estimated 22% of readmissions for decompensated cirrhosis could have been prevented, in many cases by closer adherence to evidence-based guidelines 6…”

Section: Introductionmentioning

confidence: 99%

Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

et al. 2020

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BackgroundTechnology represents a promising tool to improve healthcare delivery for patients with cirrhosis. We sought to assess utilisation of technology and preferred features of a digital health management tool, in patients with an early readmission for decompensated cirrhosis.MethodsWe conducted a cross-sectional study of patients readmitted within 90 days for decompensated cirrhosis. A semistructured interview obtained quantitative and qualitative data through open-ended questions.ResultsOf the 50 participants, mean age was 57.6 years and mean (range) model for end stage liver disease was 22.7 (10–46). Thirty-eight (76%) patients own a Smartphone and 62% have regular access to a computer with internet. Thirty-nine (78%) patients would consider using a Smartphone application to manage their cirrhosis. Forty-six (92%) patients report having a principal caregiver, of which 80% own a Smartphone. Patients were interested in a Smartphone application that could communicate with their physician (85%), send medication notifications to the patient (65%) and caregiver (64%), transmit diagnostic results and appointment reminders (82%), educate about liver disease (79%), regularly transmit weight data to the doctor (85% with ascites) and play a game to detect cognitive decline (67% with encephalopathy). Common themes from qualitative data include a desire to learn about liver disease and communicate with providers via digital tools.ConclusionAmong patients with cirrhosis with an early readmission for decompensation, most have Smartphones and would be willing to use a Smartphone to manage their disease. Future digital health management tools should be tailored to the use patterns and preferences of the patients with cirrhosis and their caregivers.

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Section: Introductionmentioning

confidence: 99%

Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

et al. 2020

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“…Recognizing factors associated with readmission and increased cost is crucial in order to reduce subsequent readmissions, hospital costs, morality, and ultimately improve quality of life. While age is a non-modifiable risk factors and insurance provider is challenging to modify, these patients should be targeted for interventions that are proven to reduce readmission rates, including a call from healthcare provider, early outpatient follow up and providing patients with enough supply of medications prior to discharge[ 28 , 29 ]. Patients that undergo frequent paracentesis should be evaluated early for other interventions, such as a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation in order to prevent frequent readmission and costs associated with frequent large volume paracentesis[ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

Sobotka¹,

Modi²,

Vijayaraman³

et al. 2018

WJH

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AIMTo determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites.METHODSA retrospective analysis of the nationwide readmission database (NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission.RESULTSOf the 59597 patients included in this study, 18319 (31%) were readmitted within 30 d. Majority (58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832 (50%) patients on index admission. Independent predictors of 30-d readmission included age < 40 (OR: 1.39; CI: 1.19-1.64), age 40-64 (OR: 1.19; CI: 1.09-1.30), Medicaid (OR: 1.21; CI: 1.04-1.41) and Medicare coverage (OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity (OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis (OR: 1.16; CI: 1.10-1.23), paracentesis on index admission (OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma (OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted (P-value: 0.34); however cost of care was significantly more on 30 d readmission ($30959 ± 762) as compared to index admission ($12403 ± 378), P-value: < 0.001.CONCLUSIONCirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

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“…(7,(89)(90)(91)(92)(93)(94) Most involved implementation of new multidisciplinary "chronic disease management" models or "patient care management" programs to improve postdischarge care and prevent readmission. Three studies delivered face-to-face interventions (89,92,93) and two studies used modern technologies (90,91) to assist with remote management of medications and liver disease complications. While outcome measures varied, most studies reported reduced readmission rates (including for potentially medication-preventable complications, like ascites and HE) but not medication-specific outcome measures, like adherence or MRPs.…”

Section: Patient-oriented Interventionmentioning

confidence: 99%

“…A small number of patient‐oriented interventions that mention a dedicated medication component have been conducted in people with cirrhosis (Table 3). ( 7,89‐94 ) Most involved implementation of new multidisciplinary “chronic disease management” models or “patient care management” programs to improve postdischarge care and prevent readmission. Three studies delivered face‐to‐face interventions ( 89,92,93 ) and two studies used modern technologies ( 90,91 ) to assist with remote management of medications and liver disease complications.…”

Section: Patient‐related Factorsmentioning

confidence: 99%

Improving Medication‐Related Outcomes in Chronic Liver Disease

Hayward

Weersink

2020

Hepatol. Commun.

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Patients with chronic liver disease (CLD) are becoming increasingly complex due to the rising prevalence of multimorbidity and polypharmacy. Medications are often essential to manage the underlying liver disease, complications of cirrhosis and portal hypertension, and comorbidities. However, medication‐related problems (MRPs) have been associated with adverse patient outcomes, including hospitalization and mortality. Factors that can contribute to MRPs in people with CLD are variable and often entwined. This narrative literature review discusses key barriers and opportunities to modify risk factors and improve medication‐related outcomes for people with CLD.

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HEPACONTROL. A program that reduces early readmissions, mortality at 60 days, and healthcare costs in decompensated cirrhosis

Abstract: HEPACONTROL decreases the incidence of early readmission the rate of emergency department visits and mortality at 60days in patients with decompensated cirrhosis, and it is cost-effective.

Cited by 32 publications

References 26 publications

Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

Attitudes towards digital health tools for outpatient cirrhosis management in patients with decompensated cirrhosis

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

Improving Medication‐Related Outcomes in Chronic Liver Disease

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