Outpatient telephonic transitional care after hospital discharge improves survival in cirrhotic patients

• 作者: Anastasia Sobotka Bhavana Bhagya Rao Carlos Romero-Marrero Rocio Lopez William Carey
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Quality improvement Transitional CARE OUTPATIENT MONITORING OUTCOMES assessment
• 年，卷（期）: 2019,（8）
• 页码范围: 646-655
• 页数: 10页
• 分类号: R

摘要

BACKGROUND Intervention to improve outcomes in cirrhotic patients (CP) after hospital discharge often focus on 30 d readmission rate (RR). However, recent studies suggest dissociation between RR and survival. At our center, CP are now offered outpatient telephonic transitional care (OTTC) by a care coordinator for 30 d after hospital discharge. AIM To determine the effect of OTTC on survival in CP. METHODS In this cohort study from a tertiary center, CP who received OTTC formed the intervention group. They were compared with a control group discharged during the same period. Mortality and RR were compared between the groups. RESULTS After OTTC introduction, 194 CP were discharged. After applying exclusion criteria, 169 CP (51% male, mean age 58 years ± 12 years) were included. OTTC group comprised 76 patients and was compared with 93 controls. Baseline disease and index admission related characteristics were not significantly different between the groups. The intervention group showed significantly higher 6 mo survival compared to controls (84.2% vs 68.8%;P = 0.03), while RR at 1, 3, and 6 mo were comparable. On multivariable analysis, the intervention group showed lower odds for mortality compared to the controls (hazard ratio: 0.4;95% confidence interval: 0.2-0.82;P = 0.012), while higher model for endstage liver disease scores were associated with higher mortality (hazard ratio: 1.05;95% confidence interval: 1.01-1.1;P = 0.024).CONCLUSION CP provided OTTC had higher 6 mo survival compared to controls without a difference in RR. Use of RR to gauge quality of care provided during hospitalization or subsequent transitional care programs should be revisited.