Randomized intervention and outpatient follow-up lowers 30-d readmissions for patients with hepatic encephalopathy,decompensated cirrhosis  

作　　者：Antoinette Pusateri Kevin Litzenberg Claire Griffiths Caitlin Hayes Bipul Gnyawali Michelle Manious Sean G Kelly Lanla F Conteh Sajid Jalil Haikady N Nagaraja Khalid Mumtaz 

机构地区：[1]Division of Gastroenterology,Hepatology and Nutrition,The Ohio State University Wexner Medical Center,Columbus,OH 43210,United States [2]Division of Internal Medicine,The Ohio State University Wexner Medical Center,Columbus,OH 43210,United States [3]The Ohio State University College of Medicine,The Ohio State University Wexner Medical Center,Columbus,OH 43210,United States [4]Division of Gastroenterology and Hepatology,The Ohio State Wexner Medical Center,Columbus,OH 43210,United States [5]Division of Biostatistics,The Ohio State University,Columbus,OH 43210,United States

出　　处：《World Journal of Hepatology》2023年第6期826-840,共15页世界肝病学杂志（英文版）（电子版）

基　　金：GASTR29:Prospective validation of readmission risk score and interventions to prevent readmission in patients with decompensated cirrhosis(CCTS ID#:6018).

摘　　要：BACKGROUND We previously reported national 30-d readmission rates of 27% in patients with decompensated cirrhosis(DC).AIM To study prospective interventions to reduce early readmissions in DC at our tertiary center.METHODS Adults with DC admitted July 2019 to December 2020 were enrolled and randomized into the intervention(INT) or standard of care(SOC) arms. Weekly phone calls for a month were completed. In the INT arm, case managers ensured outpatient follow-up, paracentesis, and medication compliance. Thirty-day readmission rates and reasons were compared.RESULTS Calculated sample size was not achieved due to coronavirus disease 2019;240 patients were randomized into INT and SOC arms. 30-d readmission rate was 33.75%, 35.83% in the INT vs 31.67% in the SOC arm(P = 0.59). The top reason for 30-d readmission was hepatic encephalopathy(HE, 32.10%). There was a lower rate of 30-d readmissions for HE in the INT(21%) vs SOC arm(45%, P = 0.03). There were fewer 30-d readmissions in patients who attended early outpatient follow-up(n = 17, 23.61% vs n = 55, 76.39%, P = 0.04).CONCLUSION Our 30-d readmission rate was higher than the national rate but reduced by interventions in patients with DC with HE and early outpatient follow-up. Development of interventions to reduce early readmission in patients with DC is needed.

关 键 词：Decompensated cirrhosis Hospital readmissions Interventions 

分 类 号：R575[医药卫生—消化系统]