How to improve care in outpatients with cirrhosis and ascites: A new model of care coordination by consultant hepatologists

Morando, Filippo; Maresio, Giulio; Piano, Salvatore; Fasolato, S.; Cavallin, M.; Romano, A.; Rosi, S.; Gola, Elisabetta; Frigo, Anna Chiara; Stanco, M.; Destro, C.; Rupolo, Giampietro; Mantoan, Domenico; Gatta, Angelo; Angeli, Paolo

doi:10.1016/j.jhep.2013.03.010

Cited by 152 publications

(171 citation statements)

References 23 publications

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“…For the same reason, it is possible that the main cause of hospitalization was not reported properly in the discharge sheet. This might explain why in the present series of data, HE was the most frequent reported cause of hospitalization, while in another study, among 100 patients with cirrhosis admitted at the Padua Teaching Hospital, ascites had emerged as the main cause of hospitalization [22] . Lastly, we have to take into account that in patients with upper gastrointestinal bleeding, other causes than variceal rupture could have caused the hemorrhage, explaining the apparently low percentage of related death (4.8%).…”

Section: Discussionmentioning

confidence: 50%

Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report

Pascoli

Ceranto

Nardi³

et al. 2017

Dig Dis

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Background and Aim: Liver cirrhosis is characterized by high morbidity and mortality rates. This study was addressed to evaluate the epidemiological and economic impact of cirrhosis on hospitalizations in a large population in Italy. Methods: Epidemiological analysis was performed using hospital discharge sheets of 57,720 hospitalizations due to liver disease from 2006 to 2008, selected from the Veneto regional archive. In a sample of 100 randomly selected hospitalizations, a detailed cost analysis was performed and a comparison was made with sets of patients admitted for heart failure (HF) and chronic obstructive pulmonary disease (COPD). Results: Among patients with cirrhosis, ascites emerged as the most frequent cause of admission, followed by hepatic encephalopathy, hepatocellular carcinoma, and upper gastrointestinal bleeding. Encephalopathy and ascites were the complications with the highest rates of readmission. The detailed cost analysis of hospitalizations revealed that economic expenses in the set of patients admitted for cirrhosis were about 30% higher than those for patients admitted for HF or COPD, mainly due to the longer duration of hospitalization. Conclusions: Cirrhosis has a relevant epidemiological and economic impact on hospitalizations and preventive strategies for its clinical management are warranted.

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Section: Discussionmentioning

confidence: 50%

Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report

Pascoli

Ceranto

Nardi³

et al. 2017

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“…(2, 28, 29) An Italian group analyzed the impact of a specialized post-acute care pathway among 100 patients with cirrhosis and ascites and found a significant reduction in 30-day readmission rates, compared to a well matched control group (42.4% to 15.4%). (2) To do so, they created a specialized outpatient unit staffed with dedicated hepatologists and nurses for rapid post-discharge follow-up visits where same-day endoscopy and liver ultrasound was available. An Australian group also studied a post-acute care program for patients with decompensated cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis

Tapper

Finkelstein

Mittleman

et al. 2016

Clinical Gastroenterology and Hepatology

135

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Background 30-day readmissions for hospitalized patients with cirrhosis are common, particularly for patients with hepatic encephalopathy (HE). Methods We performed a prospective pre-post study from 2010–2013 to assess the impact of a quality improvement (QI) protocol on 30-day readmissions to a transplant center’s liver unit. The intervention included a yearlong control period, a handheld checklist and an “electronic” phase incorporating checklist items into the electronic provider order entry system. The intervention included goal-directed lactulose therapy and universal rifaximin for overt HE as well as prompts for antibiotic prophylaxis of spontaneous bacterial peritonitis (SBP). 30-day readmission trends were compared to non-cirrhotic patients admitted to hospitalists and patients with decompensated cirrhosis at another center. Results 824 patients were admitted 1720 times. The average model for end-stage liver disease score on admission was 17.7 ± 7.4. The electronic phase was associated with 40% lower adjusted odds of 30-day readmission compared to control, both overall and for patients with HE. The proportion of admissions for ≥ grade 2 HE that resulted in a readmission fell from 48.9% (66/135) in the control period to 26.0% (27/104) in the electronic phase (p = 0.0003). Rifaximin use for HE and antibiotic secondary prophylaxis of SBP (on discharge) were associated with lower adjusted odds of readmission (respective OR 0.39 and 0.40). The electronic phase was associated with a lower length of stay (beta coefficient −1.34 95% CI: −2.38 – −0.32, p = 0.01). Conclusion A QI initiative using electronic decision support reduced 30-day readmissions for patients with cirrhosis.

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“…29,30 An effective outpatient follow-up program like the one developed by Morando et al (a hepatologist led special caregiving support team) can decrease the hospitalization rate and the total cost of the disease. 31 Another effective strategy for reducing costs was discussed in a study by Manos et al, where they showed that individuals with sustained virologic response (SVR) after antiviral treatment had nearly 2.5 times lower hospitalization rate than patients without SVR. 32 …”

Section: Discussionmentioning

confidence: 99%

Predictors of Inpatient Mortality and Resource Utilization for the Elderly Patients With Chronic Hepatitis C (CH-C) in the United States

et al. 2016

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How to improve care in outpatients with cirrhosis and ascites: A new model of care coordination by consultant hepatologists

Cited by 152 publications

References 23 publications

Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report

Hospitalizations Due to Cirrhosis: Clinical Aspects in a Large Cohort of Italian Patients and Cost Analysis Report

A Quality Improvement Initiative Reduces 30-Day Rate of Readmission for Patients With Cirrhosis

Predictors of Inpatient Mortality and Resource Utilization for the Elderly Patients With Chronic Hepatitis C (CH-C) in the United States

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