Patients with decompensated cirrhosis are known to have very high rates of hospitalization, putting increasing financial pressure on hospitals and physician groups to prevent these hospitalizations.
A Sunday afternoon AASLD symposium will provide attendees with an overview of the problem, identify risk factors for hospitalization and review evidence-based interventions. The 90-minute symposium is titled Preventing Hospitalizations for Populations with Decompensated Cirrhosis.
“Once they are discharged from the hospital, about a third of patients with decompensated cirrhosis get readmitted within 30 days, and about half of them within a year,” said Michael L. Volk, MD, the Robert and Gladys Mitchell professor of medicine, division head of gastroenterology and medical director of liver transplantation at Loma Linda University, CA. “Beyond the financial impact, this is obviously not good for patients because each hospitalization is associated with an increased risk of dying.”
To help prevent readmissions, Dr. Volk said steps can be taken that are fairly universal across all health systems and disease states.
“It starts with giving patients a thorough discharge summary with instructions that they can clearly understand,” he said. “Next is getting them into a follow-up clinic within a week after discharge and, finally, having resources in the outpatient setting to prevent the need for readmission.”
Elliot B. Tapper, MD, who will co-chair the symposium with Dr. Volk, said many of the issues that lead to readmission for cirrhosis patients could be addressed in an outpatient setting if the appropriate resources are available.
“The burden of this disease is tremendous, but the systems that are available to care for these patients are relatively underdeveloped,” said Dr. Tapper, assistant professor in the division of gastroenterology at the University of Michigan, Ann Arbor. “Those systems include alternatives to hospitalization for patients with cirrhosis, such as day hospitals where they can receive expert care from the nurses and hepatologists that know them. This could also include better access to outpatient resources in formal post-discharge clinics with the tools that are needed to address their needs, such as urgent paracentesis or urgent endoscopy.”
Dr. Tapper also noted that novel, patient-centered interventions are being developed, including mobile apps and modifications to electronic health record systems to maintain and facilitate communication between patients and their doctors.
“This is a major problem for U.S. health care systems, but there are concrete, relatively straightforward approaches that all health care systems should consider to optimize the care of these patients,” Dr. Tapper said. “Suboptimal care is associated with transplantation and reduced survival, so we have to continue to look for ways to improve the delivery of care for these patients in hopes of spreading best practices and stimulating discussion about how we can improve care further.”
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