Patient‐centered care: Key elements applicable to chronic liver disease

Abstract

Chronic liver disease (CLD) is a progressive illness with high symptom burden and functional and cognitive impairment, often with comorbid mental and substance use disorders. These factors lead to significant deterioration in quality of life, with immense burden on patients, caregivers, and healthcare. The current healthcare system in the United States does not adequately meet the needs of patients with CLD or control costs given the episodic, reactive, and fee-for-service structure. There is also a need for clinical and financial accountability for CLD care. In this context, we describe the key elements required to shift the CLD care paradigm to a patient-centered and value-based system built upon the Porter model of value-based health care. The key elements include (1) organization into integrated practice units, (2) measuring and incorporating meaningful patientreported outcomes, (3) enabling technology to allow innovation, (4) bundled care payments, (5) integrating palliative care within routine care, and (6) formalizing centers of excellence. These elements have been shown to improve outcomes, reduce costs, and improve overall patient experience for other chronic illnesses and should have similar benefits for CLD. Payers need to partner with providers and systems to build upon these elements and help align reimbursements with patients' values and outcomes. The national organizations such as the American Association for Study of Liver Diseases need to guide key stakeholders in standardizing these elements to optimize patient-centered care for CLD.

The experiences of people with liver disease of palliative and end‐of‐life care in the United Kingdom—A systematic literature review and metasynthesis

“…Internationally, researchers have advocated for liver disease services to be more person‐centred 51 . Where services are specifically designed to be person‐centred, there is an opportunity for individuals, carers, and HCPs to have more empowering experiences—being empowered to share knowledge, work collaboratively, and make decisions.…”

“…Internationally, researchers have advocated for liver disease services to be more person-centred. 51 Where services are specifically designed to be person-centred, there is an opportunity for individuals, carers, and HCPs to have more empowering experiences-being empowered to share knowledge, work collaboratively, and make decisions. In this review, there were examples of services designed to improve the palliative and end-of-life care experiences of people with advanced liver disease, and the people who support them.…”

Quantifying days at home in patients with cirrhosis: A national cohort study

“…[3,8,9] A recent review in "Hepatology" outlines that to provide highvalue, patient-centered care, health systems must shift care away from these high-resource settings and toward outpatient settings. [7] To promote such a change at the system level, our metrics should reflect the underlying goal because evidence suggests that metrics indeed shape the behavior of health care delivery. For example, a VA study found that increased adherence to quality metrics such as outpatient followup within 30 days of discharge after hospitalization for cirrhosis was associated with fewer inpatient days.…”

“…However, metrics such as survival and rehospitalizations are specific to acute events and do not reflect care delivered at places such as postacute care facilities and do not capture information regarding the quality of life 7 . Published works have shown that postacute care, at a skilled nursing facility, rehabilitation center, or at home, is associated with significant cost and quality-of-life implications 3,8,9 .…”

“…Published works have shown that postacute care, at a skilled nursing facility, rehabilitation center, or at home, is associated with significant cost and quality-of-life implications 3,8,9 . A recent review in “Hepatology” outlines that to provide high-value, patient-centered care, health systems must shift care away from these high-resource settings and toward outpatient settings 7 . To promote such a change at the system level, our metrics should reflect the underlying goal because evidence suggests that metrics indeed shape the behavior of health care delivery.…”