Health IT generated PROs to Improve Outcomes in Cirrhosis

健康 IT 生成 PRO 来改善肝硬化的治疗结果

• 批准号: 10374779
• 负责人: Jasmohan S Bajaj
• 金额: $ 39.46万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-11 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10374779
• 关键词: Health; generated; PROs; Improve; Outcomes

Patients with cirrhosis are prone to clinical and psycho-social issues that manifest as patient-reported outcomes (PRO), which can independently predict hospitalization, re-hospitalizations and death. Our group has studied the impact of these PRO extensively. With the increasing spread of health-related electronic devices, the relevance of health IT in the management of chronic diseases such as cirrhosis is paramount. The team has already developed and used several health IT advances to educate patients and their caregivers in inpatient and outpatient settings. These tools include Patient Buddy to prevent avoidable readmissions and EncephalApp Stroop to detect and guide therapy for cognitive dysfunction in cirrhosis. However the evaluation of these tools in a multi-center study that adapts to the status of the patients and their caregivers is required. The central hypothesis is that cirrhotic patients randomized to health IT interventions that elicit PROs in a structured outpatient setting will have a significantly greater reduction in hospital readmissions because of improved communication with their medical teams compared to standard of care regardless of scheduled return outpatient visits. This will be tested using the following two specific aims in three centers (Virginia Commonwealth University, Richmond VA Medical Center and Mayo Clinic). Specific Aim 1: To evaluate in a multi-center, randomized trial the effectiveness of PROs elicited using PatientBuddy and EncephalApp with and without scheduled outpatients return visits on the prevention of avoidable 30 day readmissions in patients with cirrhosis and their caregivers compared to standard of care. We will include 450 total cirrhotic patients and 450 caregivers (150 patients and 150 caregivers per center), who will be followed for 30 days post-discharge. The groups will be randomized 1:1:1 into a standard of care group, a group receiving health IT interventions who will receive PatientBuddy and EncephalApp with as-needed follow-up and another group that receives the same health IT interventions along with scheduled outpatient visits and calls within 30 days of discharge. Avoidable readmissions will be adjudged using a blinded adjudication committee and the differences between the three groups will be compared. Specific aim 2: To incorporate the opinion of key stakeholders (patients, caregivers and nurse managers) towards improving the Patient Buddy App in the prevention of readmission in cirrhosis. As part of this trial, we will also elicit feedback regarding the ease, safety and personal effectiveness of these interventions as well as their personal comfort and educational value of the App with and without the scheduled outpatient follow-up, from the patients, caregivers and administering staff. This will be compared between centers and used to enhance the Patient Buddy App in collaboration with our technology partners. The updated App will then be available for future studies in larger cirrhosis populations.

肝硬化患者容易出现临床和心理社会问题，这些问题表现为患者报告 结果（Pro）可以独立预测住院，重新住院和死亡。我们的小组 已经广泛研究了这些Pro的影响。随着与健康相关的电子的扩散不断增加 设备，健康IT在慢性疾病（例如肝硬化）的管理中的相关性至关重要。这 团队已经开发并使用了几种健康状况，以教育患者及其护理人员 住院和门诊设置。这些工具包括病人的好友，以防止可避免的再入院和 脑脑中的脑静脉曲张，以检测和指导治疗肝硬化的认知功能障碍。但是评估 在一项多中心研究中，这些工具需要适应患者及其护理人员的状况。 中心假设是肝硬化患者随机将其用于健康的IT干预措施，从而引起专业人士 结构化门诊环境将使医院再入院率明显更大 由于与医疗团队的沟通相比，与护理标准相比 不论预定的返回门诊就诊。这将使用以下两个特定目标对此进行测试 三个中心（弗吉尼亚联邦大学，里士满弗吉尼亚州医学中心和梅奥诊所）。 特定目的1：在多中心，随机试验中评估使用的优点的有效性 预防预防的患者顾问和脑脑在没有安排的门诊儿返回访问 与标准相比 照顾。我们将包括450名肝硬化患者和450名护理人员（每人150名患者和150名护理人员 中心），将在入院后30天进行。这些组将被随机化为标准 Care Group，一个接受健康IT干预措施的小组，他们将接受患者的顾问和脑 需要进行相同健康干预措施以及计划的随访和另一个小组 出院后30天内的门诊就诊和呼叫。可以使用盲人裁定可避免的再入院 裁决委员会和三组之间的差异将进行比较。 具体目标2：纳入关键利益相关者（患者，护理人员和护士）的意见 经理）旨在改善病人的好友应用程序，以预防肝硬化的再入院。作为 这项试验的一部分，我们还将引起有关这些试验的便利性，安全性和个人有效性的反馈 有和没有计划的 病人，护理人员和管理人员的门诊后续行动。这将被比较 中心，用于与我们的技术合作伙伴合作增强患者的好友应用程序。这 然后，更新的应用程序将用于对较大肝硬化人群的以后研究。

项目成果

Minimal Hepatic Encephalopathy and Mild Cognitive Impairment Worsen Quality of Life in Elderly Patients With Cirrhosis.

• DOI: 10.1016/j.cgh.2020.03.033
• 发表时间: 2020-12
• 期刊: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
• 作者: Bajaj JS;Duarte-Rojo A;Xie JJ;Acharya C;Wade JB;Robles C;Thacker LR;Flud C;Fagan A;Garcia-Saenz-de-Sicilia M;White MB;Kelly M;Nguyen V;Gavis EA;Vargas HE
• 通讯作者: Vargas HE

What diet should I recommend my patient with Hepatic Encephalopathy?

• DOI: 10.1007/s11901-020-00510-4
• 发表时间: 2020-03
• 期刊: Current hepatology reports
• 作者: Shaw J;Tate V;Hanson J;Bajaj JS
• 通讯作者: Bajaj JS

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.

• DOI: 10.2196/24639
• 发表时间: 2021-04-09
• 期刊: Journal of medical Internet research
• 影响因子: 7.4
• 作者: Acharya C;Sehrawat TS;McGuire DB;Shaw J;Fagan A;McGeorge S;Olofson A;White MB;Gavis E;Kamath PS;Bergstrom L;Bajaj JS
• 通讯作者: Bajaj JS

Sex is associated with differences in gut microbial composition and function in hepatic encephalopathy.

• DOI: 10.1016/j.jhep.2020.06.046
• 发表时间: 2021-01
• 期刊: Journal of hepatology
• 影响因子: 25.7
• 作者: Saboo K;Shamsaddini A;Iyer MV;Hu C;Fagan A;Gavis EA;White MB;Fuchs M;Heuman DM;Sikaroodi M;Iyer RK;Gillevet PM;Bajaj JS
• 通讯作者: Bajaj JS

Cost-effectiveness of integrating gut microbiota analysis into hospitalisation prediction in cirrhosis.

• DOI: 10.1002/ygh2.390
• 发表时间: 2020-03
• 期刊: GastroHep
• 作者: Bajaj JS;Acharya C;Sikaroodi M;Gillevet PM;Thacker LR
• 通讯作者: Thacker LR