The Transitional Liver Clinic (TLC): Reducing Liver Disease Readmission

过渡肝脏诊所 (TLC)：减少肝病再入院

• 批准号: 10587530
• 负责人: Eric Orman
• 金额: $ 70.76万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10587530
• 关键词: Acute; Address; Alcoholic Hepatitis; American; Area; Ascites; Caring; Characteristics; Chronic lung disease; Client satisfaction; Clinic; Clinical; Cognition Disorders; Communication; Communities; Complex; Data; Disease; Education; Elderly; Emergency department visit; Gastrointestinal Hemorrhage; Health; Healthcare; Heart failure; Hepatic Encephalopathy; Hepatology; Hospitalization; Hospitals; Impaired cognition; Indiana; Individual; Intervention; Lead; Liver; Liver Cirrhosis; Liver diseases; Medical; Medication Errors; Medication Management; Modeling; Outcome; Patient Care; Patient Discharge; Patient Readmission; Patient-Focused Outcomes; Patients; Peritoneal Fluid; Persons; Population; Provider; Quality of life; Questionnaires; Randomized; Randomized, Controlled Trials; Reporting; Research Personnel; Resources; Schedule; Severity of illness; Substance Use Disorder; System; Telephone; Testing; Time; Transitional Care Planning; Treatment Protocols; Universities; Visit; Work; cohort; comorbidity; experience; follow-up; health care delivery; health care service utilization; hospital readmission; implementation science; improved; improved outcome; innovation; mortality; multidisciplinary; participant enrollment; programs; provider communication; randomized trial; randomized, clinical trials; satisfaction; secondary outcome; telehealth; tertiary care; treatment as usual; treatment optimization; treatment planning; trial comparing

PROJECT SUMMARY/ABSTRACT Individuals with liver cirrhosis and alcoholic hepatitis often experience the complications of advanced liver disease: ascites, hepatic encephalopathy, and gastrointestinal bleeding. These complications frequently lead to hospitalizations, and after hospital discharge, disease complications can interact with medication errors and poor provider communication, resulting in frequent early hospital readmissions. Outcomes during the vulnerable post-discharge transition period could be improved through better transitional care (TC), focused on optimizing treatment regimens, improving communication, and facilitating access to community and other healthcare resources. TC addressing these issues has successfully improved outcomes in heart failure and other conditions, but there are few data on TC programs in patients with advanced liver disease, who suffer from unique clinical complications that can complicate TC treatment plans. To address this gap in our healthcare delivery system, we have developed an advanced practice provider (APP)-led TC program for patients with the complications of advanced liver disease: the Transitional Liver Clinic (TLC). In the TLC, patients discharged from the hospital with complications of advanced liver disease are contacted by telephone within two days of discharge, followed by a face-to-face or video telehealth visit with the APP within 7-14 days. During this time, TLC providers reconcile and manage medications, provide education and linkage to community resources, and facilitate necessary follow-up. This proposal aims to test the effect of the TLC on hospital readmissions, quality of life, and patient satisfaction with care. The hypothesis is that the TLC will improve patient outcomes across these domains. To achieve these aims, the TLC will be evaluated using a pragmatic stepped-wedge randomized controlled trial comparing the TLC to usual care at four high-volume tertiary care liver centers. Upon completion of the study, the investigators will have provided evidence for the efficacy of TC in reducing acute healthcare utilization and in improving quality of life and patient satisfaction for those with complications of advanced liver disease.

项目概要/摘要 肝硬化和酒精性肝炎患者经常会出现晚期肝脏并发症 疾病：腹水、肝性脑病、消化道出血。这些并发症常常导致 住院期间和出院后，疾病并发症可能与用药错误相互作用， 提供者沟通不畅，导致频繁的早期再入院。期间的成果 通过更好的过渡护理（TC）可以改善脆弱的出院后过渡期，重点是 优化治疗方案、改善沟通、促进社区和其他方面的接触 医疗保健资源。 TC 解决这些问题已成功改善心力衰竭和 其他病症，但关于晚期肝病患者的 TC 计划数据很少，这些患者患有 独特的临床并发症可能会使 TC 治疗计划复杂化。为了解决我们的这一差距 医疗保健服务系统，我们开发了一个由高级实践提供商 (APP) 主导的 TC 计划 患有晚期肝病并发症的患者：过渡肝脏诊所（TLC）。在薄层色谱法中， 通过电话联系患有晚期肝病并发症的出院患者 出院后两天内进行，然后在 7-14 天内通过 APP 进行面对面或视频远程医疗就诊。 在此期间，TLC 提供者协调和管理药物、提供教育和联系 社区资源，并促进必要的后续行动。该提案旨在测试 TLC 对 再入院、生活质量以及患者对护理的满意度。假设 TLC 将 改善这些领域的患者治疗效果。为了实现这些目标，将使用 TLC 进行评估 务实的阶梯楔形随机对照试验，在四个大容量项目中将 TLC 与常规护理进行比较 三级护理肝脏中心。研究完成后，研究人员将提供证据 TC 在减少紧急医疗保健利用率以及提高生活质量和患者满意度方面的功效 患有晚期肝病并发症的人。